Prognostic value of fibrinogen‑to‑albumin ratio in patients with gastric cancer receiving first‑line chemotherapy

Abstract

The fibrinogen-to-albumin ratio (FAR), reflecting the systemic coagulation, nutritional and inflammation status of patients, has matured into a prognostic marker for several tumor types. However, only a few studies have assessed the utility of the FAR as a prognostic indicator in patients with advanced gastric cancer (GC) receiving first-line chemotherapy. In the present study, 273 patients with advanced GC who received first-line chemotherapy between January 2014 and January 2019 at the Cancer Hospital of China Medical University (Shenyang, China) were retrospectively analyzed. Using the cutoff values determined by receiver operating characteristic (ROC) analysis, the patients were divided into low-FAR (≤10.03) and high-FAR (>10.03), low-fibrinogen (<3.8 g/l) and high-fibrinogen (≥3.8 g/l), and low-albumin (<40.55 g/l) and high-albumin (≥40.55 g/l) groups. The associations of the pretreatment FAR and clinicopathological characteristics with progression-free survival (PFS) and overall survival (OS) were evaluated. In order to estimate the prognostic value of the FAR for patients with poor prognosis or normal fibrinogen and albumin levels, subgroup analyses were performed. The FAR had a higher area under the ROC curve (0.690; 95% CI: 0.628-0.752; P<0.001) compared with either fibrinogen or albumin alone, which are common indicators of coagulation, nutritional and inflammatory indices. A high FAR was significantly associated with a more advanced stage, peritoneal metastasis, increased CA72-4 levels and anemia (all P<0.05). On survival analysis, a low FAR was associated with a longer PFS and OS compared with a high FAR (202 vs. 130 days and 376 vs. 270 days, respectively; both P<0.001), while the hazard ratio (HR) and P-values of the FAR were lower compared with those of fibrinogen and albumin alone on multivariate analysis (PFS: HR= 0.638, 95% CI: 0.436-0.932, P= 0.020; OS: HR= 0.568, 95% CI: 0.394-0.819, P= 0.002). Subgroup analysis indicated that among patients with poor prognosis, including multiple metastases, TNM stage IV and abnormal CA72-4 levels, the FAR may be used as an accurate prognostic marker (all P<0.05), and may also reliably identify patients with poor prognosis among those with normal fibrinogen and albumin levels (all P<0.001). The FAR was indicated to be a valuable marker for predicting PFS and OS in patients with advanced GC receiving first-line chemotherapy and is superior to either fibrinogen or albumin alone.

Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease

“…32 Similarly, in cancer studies, FAR was a valuable marker that could predict progression-free survival and overall survival and a stronger prognostic factor than FIB and ALB alone in breast, gallbladder, renal and gastric cancer and in glioblastoma. [14][15][16]33,34 In accordance with these results, we also found that FAR had the highest OR and possessed the most predictive value in DKD and was superior to FIB and ALB. Moreover, fully adjusted spline regression showed a significant correlation of continuous FAR with DKD incidence and the risk abruptly increased when FAR exceeded 67.3mg/g.…”

“…13 Fibrinogen to albumin ratio (FAR) is a more significant prognostic marker than each single marker itself in cancer study. [14][15][16] We speculated that FAR is also closely related to DKD.…”

“…10,13 Fibrinogen to albumin ratio (FAR) could be a more significant prognostic marker than each single marker itself in cancer study. [14][15][16] Previous studies showed that FAR could predict severity of coronary artery disease and all-cause mortality in patients with myocardial infarction. [28][29][30][31] Patients with exaggerated metabolic syndrome had a higher FAR and FAR may be a better predictor than FIB and ALB of exaggerated metabolic syndrome.…”

The Prognostic Significance of the Fibrinogen-to-Albumin Ratio in Patients With Triple-Negative Breast Cancer: A Retrospective Study

“…Moreover, tumor necrosis factor (TNF)- α selectively inhibits ALB gene expression and reduces ALB level ultimately ( 44 , 45 ). FAR is a more comprehensive serum marker, reflecting the inflammation and nutritional status of patients with tumors, and acting as a new promising prognostic indicator ( 46 ). The FAR and fibrinogen-prealbumin ratio (FPR) for patients with cancer were assessed in a meta-analysis.…”

Fibrinogen–Albumin Ratio Index Exhibits Predictive Value of Neoadjuvant Chemotherapy in Osteosarcoma

“…Recent evidence showed that FARI has potential value in the early detection of cancer, and the significantly higher FARI was found in colorectal cancer patients compared with healthy controls. 15 Moreover, increasing research suggests that FARI is also a good prognostic factor for various tumors, such as gastric tumor, 16 , 17 non-small cell lung tumor, 18 gallbladder tumor, 19 prostate tumor, 20 breast tumor, 21 and hepatocellular tumor. 22 In colorectal and gallbladder cancer patients, higher FARI scores are observed in patients with unfavorable overall survival.…”