Prognostic Significance of Preoperative Fibrinogen‐to‐Prealbumin Ratio in Patients with Stage I–III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study

Abstract

Background. The objective of this study was to explore the role of preoperative fibrinogen-to-prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I–III colorectal cancer (CRC). Methods. This retrospective study enrolled 584 stage I–III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan-Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time-dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results. FPR was determined to be an independent factor affecting postoperative complications. Patients with a low-FPR had a significantly better prognosis than those with a high-FPR (disease-free survival, p = 0.028 ; overall survival, p = 0.027 ), especially patients with stage I CRC (disease-free survival, p = 0.015 ; overall survival, p = 0.017 ). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease-free survival (hazard ratio HR = 1.459 , 95% confidence interval CI = 1.074 –1.954, p = 0.011 ) and overall survival ( HR = 1.405 , 95% CI = 1.034 –1.909, p = 0.030 ). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions. FPR is a potential indicator for predicting short- and long-term prognosis of stage I–III CRC patients undergoing surgical resection.

Fibrinogen-to-prealbumin ratio: A new prognostic marker of resectable pancreatic cancer

“…that FPR can evaluate the prognosis of malignant tumors such as colorectal cancer, hepatocellular carcinoma, esophageal cancer and gastric cancer (13)(14)(15)35). A recent meta-analysis pointed out that high value of FPR is associated with poorer survival and increased risk of recurrence in cancer patients (36).…”

The Prognostic value of the Fibrinogen to pre-albumin ratio in malignant tumors of the digestive system: a systematic review and meta-analysis

“…Mounting studies have shown that pre-albumin(PA) and fibrinogen regulate the occurrence and development of various tumors, and their levels in peripheral blood are closely related to the patient's survival and sensitivity to therapy [ 31 , 32 ].As a novel, effective, economical and practical biomarker, the fibrinogen to pre-albumin ratio (FPR) is not only gradually used to evaluate the prognosis of digestive system tumors such as colorectal cancer [ 20 ], hepatocellular carcinoma [ 16 ] and gastric cancer [ 13 ], but also as an index to predict the prognosis of lung [ 33 ] and bladder cancer [ 34 ]. A study of patients with NSCLC reported that FPR is an independent factor affecting OS in patients with advanced NSCLC [ 33 ].…”

“…Single markers of fibrinogen and pre-albumin are limited and unstable in predicting the prognosis of digestive system tumors [ 13 ]. Hailun Xie et al [ 20 ] found that pre-albumin and fibrinogen themselves do not affect postoperative complications and long-term prognosis of patients with colorectal cancer, while FPR can be used as a predictor of postoperative complications and long-term prognosis of colorectal cancer. FPR can not only reflect the level of inflammation in patients, but also indicate the nutritional status of patients [ 35 ].Patients with high FPR have reduced nutritional levels and a reduced burden of cancer-related inflammation, which can lead to impaired immune detection and recovery [ 36 ].…”

Combined preoperative prognostic nutritional index and D-dimer score predicts outcome in colorectal cancer

“…All tests were performed within one week before curative surgery as previously described [ 35 , 36 ]. The PNI was calculated as previously described [ 37 ], and patients were divided into PNI-low or -high and DD-low or -high subgroups based on the optimal cutoff points described in the statistical results below. Subsequently, patients were divided into 3 subgroups: PDS 0, PNI low and DD high; PDS 1, PNI/DD low or PNI/DD high; and PDS 2, PNI high and DD low.…”

“…Subsequently, patients were divided into 3 subgroups: PDS 0, PNI low and DD high; PDS 1, PNI/DD low or PNI/DD high; and PDS 2, PNI high and DD low. Additional systematic inflammatory prognostic indicators, such as the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR), were also calculated according to a previous report [ 37 ].…”