A new prognostic perspective on preoperative coagulation parameters for lung adenocarcinoma patients: development and validation of the DFP score

BACKGROUND: Emerging evidence suggests a pivotal role of coagulation-related factors in tumor progression and survival outcomes. However, their integration into risk stratification models remains limited. This study aimed to develop and validate a novel prognostic scoring system based on preoperative coagulation parameters to improve survival prediction in surgically treated lung adenocarcinoma (LUAD) patients. METHODS: A total of 1081 patients with pathologically confirmed LUAD who underwent pulmonary resection at a single center were retrospectively enrolled and divided into training (n = 793), testing (n = 198), and validation (n = 90) cohorts. Least absolute shrinkage and selection operator (LASSO) Cox regression, followed by multivariate Cox analysis, was performed to identify prognostic coagulation-related markers. A composite score-DFP was developed based on D-dimer (DD), fibrinogen (FIB), and prothrombin time (PT). Propensity score matching (PSM) and multivariate Cox regression were employed to adjust for baseline, surgical, and treatment-related confounders. Survival discrimination was assessed by Kaplan-Meier analysis, time-dependent receiver operating characteristic curves, and nomogram calibration and validation. RESULTS: Multivariate analysis confirmed that preoperative DD, FIB, and PT were independent predictors of overall survival (OS). The derived DFP score demonstrated prognostic value, with 1-year AUCs of 0.81, 0.77, and 0.77 in the training, testing, and independent validation cohorts, respectively. Patients with high DFP scores had significantly worse OS and disease-free survival (DFS) (P < 0.01). Exploratory stratified analyses suggested that the prognostic value of the DFP score was observed across different surgical and postoperative treatment subgroups. The nomogram integrating the DFP score with TNM stage demonstrated good calibration, clinical utility, and discriminative accuracy. CONCLUSIONS: The DFP score, comprising three routinely measured coagulation parameters, may serve as a prognostic marker in surgically treated LUAD patients. This scoring system may provide a convenient adjunct to conventional clinicopathological assessment for preoperative risk stratification.