Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors

Abstract

Background: Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression. Herein, we examined the role of fibrinogen-to-albumin ratio index (FARI) in the prognosis of gastrointestinal stromal tumors (GISTs) and developed a novel nomogram predicting recurrence-free survival (RFS). Methods: We retrospectively analyzed data from 357 GIST patients admitted at the gastrointestinal surgery of the Beijing Hospital from January 2008 to January 2018 and underwent curative resection. FARI was calculated as fibrinogen level (g/L) /albumin level (g/L). The cutoff point of FARI was set using the point with the largest Youden index on the receiver operating characteristic curve with the 5-years recurrence-free survival as an endpoint. We used the Kaplan-Meier approach and multivariable Cox regression model to study the impact of FARI on recurrence-free survival. Finally, we developed a nomogram based on tumor size, location, mitotic index, and FARI to predict RFS. The nomogram was assessed by calculating concordance probabilities and testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with the National Institute of Health (NIH) risk classification system. Results: The ROC curve revealed that the best cutoff point of the FARI was set as 0.08. The patients were classified into the FARI-high (≥0.08) and FARI-low (<0.08) groups. FARI was significantly associated with age, size of the tumor, NIH risk category, and Mitotic Index (all P < 0.05). FARI was weakly associated with NLR and PLR. FARI and PNI had a weak negative association. Multivariate analysis showed that the NIH risk category and FARI were independent prognostic predictors for worse outcomes concerning RFS in GIST patients. In the high-risk subgroup, patients with low FARI also had a more prolonged RFS than patients with high FARI (P <0.05). The nomogram had a concordance probability of 0.802 (SE 0.025). Nomogram predictions were well-calibrated. Concordance probabilities of the nomogram were better than NIH risk classification system [0.802 [0.025] vs. 0.737 [0.024], p < 0.01].

Fibrinogen/Albumin Ratio Index is An Independent Predictor of Recurrence-Free Survival in Patients With Intrahepatic Cholangiocarcinoma Following Surgical Resection

“…In this study, we evaluated the prognostic value of FARI for ICC. The optimal cutoff value for FARI in the ROC curve analysis was 0.084, which diverges from the value of 0.076 reported for colorectal liver metastases [20] and the value of 0.08 in gallbladder cancer [22]. The reason for this discrepancy in the cutoff value among tumor types is unclear, but it may be attributable to differences in the biological characteristics of each tumor.…”

“…Immunologic markers are in uenced by infection and bone marrow suppression induced by chemotherapy, radiotherapy, or other factors, which reduces their predictive value. As a biochemical marker, FARI is more stable in the circulation and has been used to evaluate long-term prognosis in various cancers including pancreatic ductal adenocarcinoma [32], gastrointestinal stromal tumors [20], and colorectal liver metastases [21]. In this study, we evaluated the prognostic value of FARI for ICC.…”

“…Poor nutritional status has also been linked to reduced survival rates in cancer [18,19]. The brinogen/albumin ratio index (FARI) was recently established to evaluate long-term survival in cancer patients [20][21][22] based on the nding that a higher FARI was associated with worse prognosis. However, the value of FARI in predicting the outcome of ICC patients undergoing hepatectomy is unknown.…”

Fibrinogen/albumin ratio index is an independent predictor of recurrence-free survival in patients with intrahepatic cholangiocarcinoma following surgical resection

“…Immunologic markers are influenced by infection and bone marrow suppression induced by chemotherapy, radiotherapy, or other factors, which reduces their predictive value. As a biochemical marker, FARI is more stable in the circulation and has been used to evaluate long-term prognosis in various cancers including pancreatic ductal adenocarcinoma [39], gastrointestinal stromal tumors [26], and colorectal liver metastases [27]. In this study, we evaluated the prognostic value of FARI for ICC.…”

“…Poor nutritional status has also been linked to reduced survival rates in cancer [24,25]. The fibrinogen/albumin ratio index (FARI) was recently established to evaluate long-term survival in cancer patients [26][27][28][29] based on the finding that a higher FARI was associated with worse prognosis. However, the value of FARI in predicting the outcome of ICC patients undergoing hepatectomy is unknown.…”