Abstract 296: Pre-treatment clinical laboratory tests indicative of metabolic status are associated with survival in patients with non-small cell lung cancer
Authors: Zhang Fanmao , Meng Qing H. , Ye Yuanqing , Hildebrandt Michelle AT , Huang Maosheng , Wu Xifeng 
Published: May 2015

Abstract
The value of serum pre-treatment laboratory tests for prognostic purposes in non-small cell lung cancer (NSCLC) is mixed, with inconsistent results. This study was designed to identify pre-treatment routine laboratory tests indicative of a patient's overall metabolic status, as predictors of NSCLC survival. We assessed seven pre-treatment serum laboratory test levels, including alanine aminotransferase, albumin, alkaline phosphatase, glucose, lactate dehydrogenase, total bilirubin, and total protein in 2,675 NSCLC patients, among which 2,201 patients were Caucasians. There were 623 early stage and 2,052 advanced stage NSCLC patients. To minimize the effect of treatment heterogeneity, we focused on subgroups of patients with similar treatment regimens. We studied 978 advanced stage NSCLC patients who were treated with platinum-based chemotherapy. Compared to those with pre-treatment laboratory test levels within the normal range, lower than normal levels of albumin [adjusted hazard ratio (HR) = 1.47, 95% confidence interval (CI): 1.15-1.87, P &lt; 0.01], higher than normal levels of alkaline phosphatase (HR = 1.31, 95% CI: 1.08-1.58, P &lt; 0.01) and higher than normal levels of lactate dehydrogenase (HR = 1.60, 95% CI: 1.34-1.92, P &lt; 0.0001) were all associated with a worse 2-year overall survival, after adjusting for age, gender, ethnicity, smoking status, clinical stage, performance status, and treatment regimens. We also stratified the analysis by age, gender, ethnicity, smoking status, clinical stage and performance status, and similar results were found. Moreover, we identified the cumulative effects of these adverse lab tests ─ compared to patients with no adverse lab tests, NSCLC patients with one adverse lab test exhibited a 38% increased risk of death at two years (HR = 1.34; 95% CI: 1.12-1.60, P &lt; 0.01), and patients with two or more adverse lab tests exhibited two-fold (HR = 2.00; 95% CI: 1.57-2.56, P &lt; 0.0001) increased risk of death at two years. A risk score generated based on the lab test levels distinguished patients into two groups with high- and low-risk of death. Patients with a high-risk score had a median survival time of 12.8 months compared to 19.6 months for those with a low-risk score (P &lt; 0.0001). Our results suggest that pre-treatment routine laboratory test levels could be utilized to enhance predictions of survival among advanced stage NSCLC patients treated with platinum-based chemotherapy.
Citation Format: Fanmao Zhang, Qing H. Meng, Yuanqing Ye, Michelle AT Hildebrandt, Maosheng Huang, Xifeng Wu. Pre-treatment clinical laboratory tests indicative of metabolic status are associated with survival in patients with non-small cell lung cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 296. doi:10.1158/1538-7445.AM2014-296