Application of Monocyte-to-Albumin Ratio and Neutrophil Percentage-to-Hemoglobin Ratio on Distinguishing Non-Small Cell Lung Cancer Patients from Healthy Subjects

Figures & data

Table 1 Clinical Baseline Characteristics of the NSCLC Group and the Healthy Controls

Variable	The Normal Range	NSCLC Patients	Healthy Participants	P values
		(n=195)	(n=204)
Age (years)	–	58 (42, 77)	59±5	0.955
Gender				0.312
Male	–	114	109
Female	–	81	95
Smoking history	–			0.071
No	–	120	143
Yes	–	75	61
Pack years	–	10 (2.5, 30.0)	6.9 (2.5, 30.0)	0.696
Histopathological subtype (n)
AC	–	157		–
SCC	–	23		–
Other NSCLC	–	15		–
Invasion depth (n)
T1+T2	–	154		–
T3+T4	–	41		–
Lymph node metastasis (n)
N0	–	113		–
N1+N2+N3	–	82		–
Distant metastasis (n)
M0	–	143		–
M1	–	52		–
TNM stage (cases)
IA–IIB	–	118		–
IIIA-IVB	–	77		–
Laboratory parameters
White blood cell count (×10^9/L)	3.5–9.5	6.1 (5.1, 7.5)	5.6 (4.7, 6.3)	<0.001
Neutrophils (×10^9/L)	1.8–6.3	3.7 (2.9, 4.8)	3.2 (2.5, 3.9)	<0.001
Monocyte (×10^9/L)	0.1–0.6	0.4 (0.4, 0.6)	0.3 (0.3, 0.4)	<0.001
Neutrophil percentage (%)	40–75	61±9	58±7	<0.001
Hemoglobin (g/L)	115–150	136±16	149±15	<0.001
Albumin (g/L)	40.00–50.00	40±4	44±2	<0.001
CEA (ng/mL)	<5.00	2.64 (1.68, 5.57)	1.87 (1.32, 2.65)	<0.001
MAR	–	11.47 (8.68, 15.50)	6.90 (6.44, 9.10)	<0.001
NPHR	–	0.46±0.09	0.39±0.07	<0.001

Notes: Data were expressed as mean±standard deviation or medians and interquartile range [Median (Q1, Q3)]; the independent t-test or Mann–Whitney U-test was used for statistical analysis.

Abbreviations: AC, adenocarcinoma; SCC, squamous cell carcinomas, NSCLC, non-small cell lung cancer; CEA, carcinoma embryonic antigen; MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Figure 1 The levels of MAR and NPHR among I A–II B stage, III A-IV stage of NSCLC and the healthy controls. (A) MAR and (B) NPHR.***P<0.001.

Abbreviations: MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Table 2 Associations Between MAR and NPHR Levels and Clinicopathological Features in the NSCLC Group

Characteristics	n	MAR	P value	NPHR	P value
Gender			<0.001		0.748
Male	114	14.66 (10.62, 17.01)		0.45±0.10
Female	81	9.37 (6.99, 10.90)		0.46±0.08
Age			<0.001		0.063
≤ 61	129	10.00 (7.78, 14.17)		0.45±0.09
> 61	66	13.60 (10.61, 17.24)		0.47±0.10
Smoking history			<0.001		0.166
No	120	9.94 (7.82, 12.87)		0.45±0.80
Yes	75	15.06 (10.55, 18.32)		0.47±0.10
Invasion depth			0.021		<0.001
T1+T2	154	10.74 (8.08, 14.87)		0.44±0.08
T3+T4	41	13.84 (10.24, 18.22)		0.51±0.11
Lymph node metastasis			0.027		<0.001
N0	113	9.88 (7.34, 13.05)		0.43±0.07
N1-N3	82	13.61 (10.04, 17.19)		0.49±0.10
Distant metastasis			0.025		<0.001
M0	143	10.64 (7.81, 14.70)		0.44±0.08
M1	52	13.95 (9.71, 18.40)		0.50±0.10
TNM stage			0.137		<0.001
IA–IIB	118	10.16 (7.47, 13.75)		0.43±0.07
IIIA–IV	77	13.51 (9.76, 17.43)		0.50±0.10

Notes: Data were expressed as mean ± standard deviation or median (interquartile range); binary logistic regression analysis with adjustment age, gender and smoking history was used to control confounding factors; P<0.05 was considered significant.

Abbreviations: MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Table 3 Diagnostic Efficiency of MAR, NPHR, Alone or Combined, in the NSCLC Patients and the Healthy Controls

Variables	AUC	Cut-Off	Sensitivity (%)	Specificity (%)	95% CI
					Lower Limit	Upper Limit
MAR	0.812	9.66	66.2	85.3	0.769	0.854
NPHR	0.724	0.44	53.3	81.4	0.675	0.774
CEA	0.689	3.81	38.5	93.6	0.637	0.741
MAR+CEA	0.833		68.2	86.8	0.792	0.873
NPHR+CEA	0.76		59.5	82.4	0.713	0.807
MAR+NPHR	0.851		68.7	88.7	0.814	0.888
MAR+NPHR+CEA	0.86		72.8	87.3	0.824	0.896

Abbreviations: AUC, area under curve; CI, confidence interval; CEA, carcinoma embryonic antigen; MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Figure 2 (A) ROC curve analysis of the value of MAR, NPHR and CEA alone in the diagnosis between the NSCLC group and the healthy controls. (B) ROC curve analysis of the value of MAR, NPHR and CEA combined in diagnosis between the NSCLC group and the healthy controls.

Abbreviations: MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Table 4 Binary Logistic Regression Analysis of Potential Risk Factors for NSCLC

Variable	OR (95% CI)	P value
MAR	1.412 (1.292, 1.544)	<0.001
NPHR	0.183 (0.096, 0.349)	<0.001
CEA	1.200 (1.016, 1.418)	0.032

Note: NPHR levels were reciprocal-transformed in the model.

Abbreviations: OR, odds ratio; CEA, carcinoma embryonic antigen; MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Table 5 Diagnostic Efficiency of MAR and NPHR, Alone or Combined in the Early-Stage NSCLC Group and the Healthy Controls

Variables	AUC	Cut-Off	Sensitivity (%)	Specificity (%)	95% CI
					Lower Limit	Upper Limit
MAR	0.763	9.27	64.4	79.4	0.707	0.818
NPHR	0.656	0.41	62.7	72.6	0.594	0.719
CEA	0.565	1.99	56.8	55.4	0.5	0.63
MAR+NPHR	0.794		55.1	87.7	0.743	0.845

Abbreviations: AUC, area under curve; CI, confidence interval; CEA, carcinoma embryonic antigen; MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).

Figure 3 ROC curve analysis of the value of MAR, NPHR and CEA alone or combined in diagnosis between the early-stage NSCLC group and the healthy controls.

Abbreviations: CEA, carcinoma embryonic antigen; MAR, monocyte (number/mm³)/albumin (g/L); NPHR, neutrophil percentage (%)/hemoglobin (g/L).