Preoperative Fibrinogen–Albumin Ratio, Potential Prognostic Factors for Bladder Cancer Patients Undergoing Radical Cystectomy: A Two-Center Study

Abstract

Background:We conducted a two-center study to investigate the prognostic value of preoperative fibrinogen-albumin ratio (FAR) in patients undergoing radical cystectomy (RC). Methods: The clinical and survival data of 267 patients with bladder cancer (BCa) treated with RC were collected, of which 140 patients from Xuzhou Central Hospital were divided into training set and 127 patients from The Second Affiliated Hospital of Nantong University were divided into validation set. X-tile software was used to obtain the optimal cut-off values for preoperative platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and FAR. Receiver operating characteristic (ROC) curves were used to compare the predictive ability of PLR, NLR, FAR and modified Glasgow prognostic score (mGPS). Kaplan-Meier curves were used to assess overall survival (OS) and progression-free survival (PFS) of patients in different FAR groups. Univariate and multivariate Cox regression were used to assess patients' independent risk factors, and R software was used to construct prognostic nomograms. Results: In the training set, the optimal cut-off values for PLR, NLR and FAR were 76.76, 3.97 and 0.08, respectively. Both in the training and validation sets, FAR had better ability to predict OS and PFS than PLR and NLR, and patients in the higher FAR group had worse OS and PFS. In the multivariate Cox regression analysis, FAR was an independent risk factor for OS [hazard ratio (HR) 3.569, 95% confidence interval (CI): 1.015-12.546, P=0.047] and PFS [HR 5.071, P=0.014]. In addition, FAR-based prognostic nomograms had high predictive ability than TNM staging. Conclusion: Preoperative FAR is an independent prognostic factor for OS and PFS in BCa patients treated with RC, and a high FAR predicted a poor prognosis. In addition, a prognostic nomogram based on FAR can better predict individual survival.

The Fibrinogen/Albumin Ratio Index as an Independent Prognostic Biomarker for Patients with Combined Hepatocellular Cholangiocarcinoma After Surgery

“…As usually, low level of albumin commonly indicated malnutrition and cachexia in malignant tumor patients, which are closely correlated with worse prognosis. 30 Similar to our results, the FAR, as a new biomarker combining with blood nutritional status and blood coagulation function, has already been proven as a valuable prognostic factor in the prediction of prognosis of various malignancies, such as HCC, ICC, pancreatic cancer, etc. 21 , 22 , 31 …”

Preoperative Fibrinogen-to-Albumin Ratio as Potential Predictor of Bladder Cancer: A Monocentric Retrospective Study

“…Hwang et al evaluated the prognostic influence of preoperative FAR in breast cancer, reporting a worse prognosis for patients with a higher FAR (>7.1) [ 21 ]. Analogously, a study by Xu et al reported unfavorable overall survival in gall bladder cancer patients with FAR > 0.08 compared to patients with lower values [ 33 ]. Finally, An et al reported high FAR (>7.75) as a worse prognostic factor in cervical cancer [ 20 ].…”

The prognostic value of fibrinogen to albumin ratio in malignant tumor patients: A meta-analysis

“…In recent years, there have been continuous studies to explore the relationship between FAR and the clinical outcome of human solid tumors ( 29 , 35 , 36 , 39 ). FAR is expected to be a simple, inexpensive, and readily available biomarker for predicting clinical prognosis in patients with solid tumors.…”