{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T15:30:15Z","timestamp":1793287815635,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Accurate prognostic assessment in lung cancer is challenging, especially in settings with limited access to molecular testing. Routine hematological markers may complement TNM staging in identifying high-risk patients. Methods: We retrospectively analyzed 304 patients with histologically confirmed lung cancer to evaluate the prognostic value of hematological and inflammatory markers in relation to tumor stage and ECOG performance status. Survival was estimated using Kaplan\u2013Meier analysis and independent predictors were identified through Cox regression. Cluster analysis integrated hematological markers with tumor characteristics. Results: Most patients presented with advanced disease (61.2% T4; 57.1% metastatic). Early stages (\u2264IIC) were associated with nearly double the median overall survival compared with stages \u2265IIIA (p = 0.001). Nodal involvement and metastases further stratified outcomes. Among hematological markers, anemia (Hb &lt; 11.85 g\/dL) and leukocytosis (WBC &gt; 11.71 \u00d7 109\/L) predicted shorter survival and remained independent predictors in the multivariable Cox model (HR 1.70, p &lt; 0.001; HR 1.54, p = 0.004), along with T4 stage (HR 1.47, p = 0.015). PLT count and fibrinogen were significant in univariate analysis but not after adjustment, while CRP and D-dimer showed no association. Cluster analysis identified two subgroups, with patients in Cluster 2 (T4 stage, anemia, leukocytosis) experiencing more than double the mortality risk compared with Cluster 1 (HR 2.33, p &lt; 0.001). Conclusions: TNM stage remains the dominant prognostic factor in lung cancer. However, Hb and WBC count provide additional prognostic information, and cluster analysis may refine risk stratification by capturing clinically relevant heterogeneity.<\/jats:p>","DOI":"10.3390\/jcm14217603","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:16:24Z","timestamp":1761729384000},"page":"7603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic Value of Routine Hematological Markers and ECOG Performance in Predicting Overall Survival in Lung Cancer\u2014A Retrospective Cohort Study and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Denisa-Gabriela","family":"Ion-Andrei","sequence":"first","affiliation":[{"name":"Medical Doctoral School, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Department of Pneumology, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6835-2285","authenticated-orcid":false,"given":"Alexandra-Cristiana","family":"Gache","sequence":"additional","affiliation":[{"name":"Medical Doctoral School, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Department of Pneumology, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2386-543X","authenticated-orcid":false,"given":"Elena","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Department of Public Health and Management, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Cristina","family":"Postu","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona-Alina","family":"Lup\u0219\u0103","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Mocanu","sequence":"additional","affiliation":[{"name":"\u201cSt. Apostle Andrew\u201d Emergency County Clinical Hospital, 145 Tomis Street, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina","family":"Muntean","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6591-0038","authenticated-orcid":false,"given":"Elena","family":"Dantes","sequence":"additional","affiliation":[{"name":"Medical Doctoral School, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Department of Pneumology, Faculty of Medicine, Campus\u2014Corp B, Ovidius University of Constanta, 1 University Alley, 900470 Constanta, Romania"},{"name":"Clinical Hospital of Pneumophthysiology, 40 Sentinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102693","DOI":"10.1016\/j.canep.2024.102693","article-title":"Global Burden of Lung Cancer in 2022 and Projections to 2050: Incidence and Mortality Estimates from GLOBOCAN","volume":"93","author":"Zhou","year":"2024","journal-title":"Cancer Epidemiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejca.2022.01.007","article-title":"Persisting cancer mortality gap between western and eastern Europe","volume":"165","author":"Santucci","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_4","first-page":"3098","article-title":"Prognostic significance of the neutrophil to lymphocyte ratio in patients with non-small cell lung cancer: A systemic review and meta-analysis","volume":"8","author":"Peng","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Xu, W., Liu, X., Ci, Y., Abdurahmane, G., Lazibiek, J., Zhang, Y., and Cao, M. (2024). The prognostic value and model construction of inflammatory markers for patients with non-small cell lung cancer. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-57814-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3349\/ymj.2012.53.1.111","article-title":"Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer","volume":"53","author":"Hong","year":"2012","journal-title":"Yonsei Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8103","DOI":"10.1200\/jco.2013.31.15_suppl.8103","article-title":"Prognostic value of ECOG performance status in lung cancer assessed by patients and physicians","volume":"31","author":"Johansen","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.3324\/haematol.2011.054718","article-title":"High D-dimer levels are associated with poor prognosis in cancer patients","volume":"97","author":"Ay","year":"2012","journal-title":"Haematologica"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","article-title":"Toxicity and response criteria of the Eastern Cooperative Oncology Group","volume":"5","author":"Oken","year":"1982","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gomez, P., Tartari, C., Russo, L., Bolognini, S., Ticozzi, C., Romeo, D., Schieppati, F., Barcella, L., Falanga, A., and Marchetti, M. (2025). Thromboinflammatory biomarkers are early predictors of disease progression in non-small cell lung cancer patients. Cancers, 17.","DOI":"10.3390\/cancers17121932"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Moik, F., M\u00fcller, S., Posch, F., Pabinger, I., and Ay, C. (2020). Systemic inflammation and activation of haemostasis predict poor prognosis and response to chemotherapy in patients with advanced lung cancer. Cancers, 12.","DOI":"10.3390\/cancers12061619"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2147\/OTT.S444396","article-title":"Prognostic factors and construction of nomogram prediction model of lung cancer patients using clinical and blood laboratory parameters","volume":"17","author":"Zhang","year":"2024","journal-title":"Onco Targets Ther."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tian, H., Li, G., Hou, W., Jin, J., Wang, C., Ren, P., Wang, H., Wang, J., Li, W., and Liu, D. (2023). Common nutritional\/inflammatory indicators are not effective tools in predicting the overall survival of patients with small cell lung cancer undergoing first-line chemotherapy. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1211752"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"114","DOI":"10.3390\/onco1020010","article-title":"Pretreatment C-Reactive Protein Predicts Survival in Small Cell Lung Cancer Patients","volume":"1","author":"Stensvold","year":"2021","journal-title":"Onco"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3904","DOI":"10.7150\/jca.26360","article-title":"Prognostic Value of Plasma Fibrinogen in Lung Cancer Patients: A Meta-Analysis","volume":"9","author":"Zhong","year":"2018","journal-title":"J. Cancer"},{"key":"ref_16","unstructured":"SEER (2025, September 04). Cancer of the Lung and Bronchus-Cancer Stat Facts, Available online: https:\/\/seer.cancer.gov\/statfacts\/html\/lungb.html."},{"key":"ref_17","first-page":"100798","article-title":"Recent survival gains in stage IV NSCLC by sociodemographic strata","volume":"6","author":"Ayoade","year":"2025","journal-title":"JTO Clin. Res. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/CEJ.0000000000000675","article-title":"Factors leading to the risk of stroke mortality: A cross-sectional study with lung cancer patient-based large sample","volume":"31","author":"Chen","year":"2022","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1097\/CM9.0000000000002729","article-title":"Persistent increase and improved survival of stage I lung cancer based on a large-scale real-world sample of 26,226 cases","volume":"136","author":"Wang","year":"2023","journal-title":"Chin. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Li, X., Tong, L., Wang, S., Yu, J., Lu, B., Wang, Q., Hu, M., Wu, J., Yu, J., and Li, B. (2024). Integration of clinical and blood parameters in risk prognostication for patients receiving immunochemotherapy for extensive stage small cell lung cancer: Real-world data from two centers. BMC Med., 22.","DOI":"10.1186\/s12916-024-03612-8"},{"key":"ref_21","unstructured":"Killeen, R.B., and Kok, S.J. (2025, August 14). D-Dimer Test, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431064\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1186\/s13019-021-01618-4","article-title":"The D-dimer level predicts the prognosis in patients with lung cancer: A systematic review and meta-analysis","volume":"16","author":"Ma","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"10","DOI":"10.21037\/jtd-22-1363","article-title":"Prognostic Value of Plasma D-Dimer Levels in Advanced Non-Small Cell Lung Cancer Patients Treated with Immune Checkpoint Inhibitors: A Retrospective Study","volume":"14","author":"Li","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21037\/jtd.2019.11.13","article-title":"The Association between Plasma Fibrinogen Levels and Lung Cancer: A Meta-Analysis","volume":"11","author":"Zhang","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sinn, K., Mosleh, B., Grusch, M., Klepetko, W., Hoetzenecker, K., Klikovits, T., Gompelmann, D., and Hoda, M.A. (2022). Impact of fibrinogen levels and modified Glasgow pognostic score on survival of stage III\/N2 non-small cell lung cancer patients treated with neoadjuvant therapy and radical resection. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-10298-9"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1111\/1759-7714.14419","article-title":"Prognostic value of preoperative plasma fibrinogen levels in resected stage I non-small cell lung cancer","volume":"13","author":"Mitsui","year":"2022","journal-title":"Thorac Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Riedl, J.M., Barth, D.A., Brueckl, W.M., Zeitler, G., Foris, V., Mollnar, S., Stotz, M., Rossmann, C.H., Terbuch, A., and Balic, M. (2020). C-Reactive Protein (CRP) Levels in Immune Checkpoint Inhibitor Response and Progression in Advanced Non-Small Cell Lung Cancer: A Bi-Center Study. Cancers, 12.","DOI":"10.3390\/cancers12082319"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8","DOI":"10.21037\/jtd-23-85","article-title":"High Level of C-Reactive Protein as a Predictive Factor for Immune-Related Adverse Events of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: A Retrospective Study","volume":"15","author":"Onodera","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_29","first-page":"1379","article-title":"Analysis of risk factors for febrile neutropenia in small-cell lung cancer patients receiving etoposide\u2013cisplatin chemotherapy","volume":"15","author":"Gong","year":"2023","journal-title":"Am. J. Cancer Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:56:12Z","timestamp":1761731772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":29,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217603"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217603","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]}}}