A combination of fibrinogen (FBG), platelet (PLT),neutrophil to lymphocyte ratio (NLR) and platelet tolymphocyte ratio (PLR) (abbreviated as CO-NPF) has beenrecently evaluated as a marker for prognostication in lungcancer. While previous study on CO-NPF has evaluated in lungadenosquamous patients, the combination of these fourmarkers has not been evaluated in advanced lungadenocarcinoma yet. In this study, we investigated thesignificance of CO-NPF in predicting the survival ofpatients with advanced lung adenocarcinoma. 225 patientswith pathologically diagnosed lung adenocarcinoma wereenrolled. The cutoff values for FBG, PLT, NLR and PLR weredefined by receiver operating characteristic (ROC). TheCO-NPF was calculated as the combination of FBG, PLT, NLRand PLR based on these cutoff values.... Kaplan-Meier analysisand Cox proportional hazard models were used to assess theprognostic value of CO-NPF. Kaplan-Meier analysis revealsthat CO-NFP was associated with poorer progressive freesurvival (PFS) [hazard ratio (HR), 0.657; 95% confidenceinterval (CI), 0.501-0.862; P=0.002] and overall survival(OS) (HR, 0.701; 95% CI, 0.523-0.938; P=0.016). Coxproportional hazard models further reveals CO-NFP as anindependent prognostic factor for PFS (HR, 0.665; 95% CI,0.504-0.876; P=0.004) and OS (HR, 0.672; 95% CI,0.495-0.914; P=0.011). CO-NPF can serve as a usefulbiomarker to predict recurrence and death for patients withadvanced lung adenocarcinoma.