FAN score comprising fibrosis-4 index, albumin–bilirubin score and neutrophil–lymphocyte ratio is a prognostic marker of urothelial carcinoma patients treated with pembrolizumab

Abstract

It is important to identify prognostic and predictive markers of metastatic urothelial carcinoma (mUC) treated with immunocheckpoint inhibitors. We sought to establish a prognostic marker for patients with mUC treated with pembrolizumab based on only blood test results. We included 165 patients with mUC in the discovery cohort and 103 with mUC who were treated with pembrolizumab in the validation cohort. Multivariate and Cox regression analyses were used to analyse the data. In the discovery cohort, the fibrosis-4 index (hazard ratio [HR]: 2.13, 95% confidence interval [CI] 1.20–3.76, p = 0.010), albumin–bilirubin score (HR 1.91, 95% CI 1.27–2.88, p = 0.002), and neutrophil–lymphocyte ratio (HR: 1.84, 95% CI 1.22–2.79, p = 0.004) were independent significant prognostic factors. We established a ‘FAN score’ that included these three aforementioned items, which were assigned one point each. We divided patients into the 0–1 point (n = 116) and 2–3 points (n = 49) groups. The FAN score was a significant prognostic marker for cancer-specific survival (CSS) (HR 1.48, 95% CI 1.19–1.83, p < 0.001) along with the Eastern Cooperative Oncology Group Performance Status. The FAN score was also a prognostic factor of progression-free survival (PFS) (HR: 1.25, 95% CI 1.01–1.54, p = 0.036) along with the presence of liver metastasis. In the validation cohort, the FAN score was a significant prognostic factor for CSS (HR: 1.48, 95% CI 1.19–1.85, p = 0.001) and PFS (HR: 1.29, 95% CI 1.02–1.62, p = 0.034). We established the FAN score as a prognostic marker for patients with mUC treated with pembrolizumab.

Albumin-to-Alkaline Phosphatase Ratio as a Prognostic Biomarker for Spinal Fusion in Lumbar Degenerative Diseases Patients Undergoing Lumbar Spinal Fusion

“…Several studies have demonstrated that ALB regulates inflammatory responses by binding to lipopolysaccharides and reactive oxygen species [ 28 ]. Moreover, data have been accumulating on the utility of albumin as a prognostic marker, including the prognostic value of different albumin parameters alone or when combined [ 29 , 30 ]. ALP catalyzes the hydrolysis of phosphate esters and is responsible for transferring phosphate groups, which are mainly produced in the liver and bone.…”

Anticancer maintenance chemotherapy prolonged prognosis of metastatic urothelial carcinoma patients: A single institute retrospective study using propensity score matching

“…Sex, age at metastasis, primary cancer site, presence of local treatment, presence of liver metastasis, the regimen of induction chemotherapy, number of induction chemotherapy cycles, the efficacy of induction chemotherapy, the Eastern Cooperative Oncology Group‐Performance Status (ECOG‐PS) score, presence of treatment with pembrolizumab after first‐line chemotherapy, serum creatinine clearance, and the serum Fib‐4 index, ALBI, and neutrophil‐to‐lymphocyte ratio (FAN) score 15 were analyzed. Local treatment included radical cystectomy, nephroureterectomy, and radiation therapy, but not transurethral resection for bladder cancer.…”

Prognostic Value of the FAN Score, a Combination of the Fibrosis-4 Index, Albumin-Bilirubin Score and Neutrophil-Lymphocyte Ratio, in Patients Hospitalized with Heart Failure

“…Blood samples were also collected at discharge, and the FIB-4 index, ALBI score and NLR were calculated using the following formulae: FIB-4 index = age (years) × aspartate transaminase (U/L) / (platelet count [10 9 /L] × alanine aminotransferase [U/L] 1/2 ) 16) ALBI score = (log10 total bilirubin [mmol/L] × 0.66) + (albumin [g/L] × -0.085) 17) NLR = neutrophil count/lymphocyte count The original FAN score was calculated using the following cut-off values: Fib-4 index > 3.5, ALBI score > -2.6, and NLR > 5.0, assigning one point for each index (minimum score 0, maximum score 3). 12) In the current study, we not only calculated the FAN score based on these criteria, but also calculated this score using different cut-off values, determined by the median values in our heart failure cohort (HF-FAN score), similarly assigning one point for each index criteria that was met (minimum score 0, maximum score 3).…”

“…[9][10][11] Recently, the FAN score, comprising the FIB-4 index, ALBI score and NLR, was developed as a useful risk stratification tool in patients with urothelial carcinoma. 12) This simple score might also be promising for heart failure since inflammation and the deterioration of liver function are associated with the development of heart failure. 13,14) However, the cut-off values of these 3 components were determined based on data from a non-heart failure population.…”

“…13,14) However, the cut-off values of these 3 components were determined based on data from a non-heart failure population. 12) Therefore, in the current study, we aimed 1) to determine the optimal cut-off values of the FAN score using our heart failure registry, and to use these cut-off values in the HF-FAN score, and 2) to compare the prognostic value of the HF-FAN score with that of the established FAN score.…”