Systemic Inflammatory Biomarkers, Especially Fibrinogen to Albumin Ratio, Predict Prognosis in Patients with Pancreatic Cancer

Abstract

Systemic inflammatory response is a critical factor that promotes the initiation and metastasis of malignancies including pancreatic cancer (PC). This study was designed to determine and compare the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and fibrinogen-to-albumin ratio (FAR) in resectable PC and locally advanced or metastatic PC. Materials and Methods Three hundred fifty-three patients with resectable PC and 807 patients with locally advanced or metastatic PC were recruited in this study. These patients were classified into a training set (n=758) and a validation set (n=402). Kaplan-Meier survival plots and Cox proportional hazards regression models were used to analyze prognosis. Results Overall survival (OS) was significantly better for patients with resectable PC with low preoperative PLR (p=0.048) and MLR (p=0.027). Low FAR, MLR, NLR (p<0.001) and PLR (p=0.003) were significantly associated with decreased risk of death for locally advanced or metastatic PC patients. FAR (hazard ratio [HR], 1.522; 95% confidential interval [CI], 1.261 to 1.837; p<0.001) and MLR (HR, 1.248; 95% CI, 1.017 to 1.532; p=0.034) were independent prognostic factors for locally advanced or metastatic PC. Conclusion The prognostic roles of FAR, MLR, NLR, and PLR in resectable PC and locally advanced or metastatic PC were different. FAR showed the most prognostic power in locally advanced or metastatic PC. Low FAR was positively correlated with OS in locally advanced or metastatic PC, which could be used to predict the prognosis.

The prognostic value of sarcopenia combined with preoperative fibrinogen–albumin ratio in patients with intrahepatic cholangiocarcinoma after surgery: A multicenter, prospective study

“… 33 , 34 , 35 Recently, another inflammation biomarker FAR was found to be associated with the prognosis of manycancers. 19 , 36 , 37 To our best knowledge, this was the first study to prove that FAR was of great significance in predicting the prognosis of ICC. Moreover, FAR would be a valuable biomarker for predicting the prognosis of ICC, because it can be easily obtained from peripheral blood examinations.…”

“…In fact, FAR has been reported as a potential prognostic factor for many malignant tumors, such as gallbladder cancer, 16 breast cancer, 17 colorectal cancer, 18 and pancreatic cancer. 19 However, the relationship between FAR and the prognosis of patients with ICC has not yet been explored.…”

Prognostic value of the preoperative fibrinogen-to-albumin ratio in pancreatic ductal adenocarcinoma patients undergoing R0 resection

“…The prognostic role of FAR has been confirmed in patients who underwent radical resection of tumors, such as esophageal cancer[ 19 ], breast cancer[ 20 , 21 ] and liver cancer[ 22 ]. It has also been reported that FAR (HR: 1.634; 95%CI: 1.359-1.964; P < 0.001) is an important prognostic factor for locally advanced or metastatic pancreatic cancer[ 25 ]. With regard to the optimal cut-off value of FAR, the value in patients who underwent radical operation for esophageal cancer was the same as ours, whereas that in patients who underwent radical operation for liver cancer was 0.062, which was lower than our value.…”

ASO Author Reflections: Lymphocyte-to-monocyte ratio as prognostic biomarker in pancreatic ductal adenocarcinoma

“…1 The neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), platelet-tolymphocyte ratio, and fibrinogen-to-albumin ratio have been used as prognostic biomarkers for pancreatic ductal adenocarcinoma (PDAC). [2][3][4] Although the usefulness of various prognostic factors has been reported, the most effective pre-operative biomarker for PDAC patients has not yet been established. Preoperative evaluation using predictors of long-term prognosis can be useful in determining the appropriate treatment for PDAC.…”