The Novel CFP Scoring System is a Reliable Marker in Predicting Response and Prognosis in Patients with Locally Advanced Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy

Abstract

Background: Preoperative tumor markers, inflammation, and nutritional status are considered important predictors of prognosis and tumor response in locally advanced rectal cancer (LARC) patients. This study aims to explore the prognostic value of carcinoembryonic antigen (CEA), the Fibrinogen-Albumin Ratio Index (FARI), the Prognostic Nutritional Index (PNI) and a combined scoring system in LARC patients.Methods: A total of 138 LARC patients undergoing radical surgery following neoadjuvant chemoradiotherapy (NCRT) between January 2012 and March 2019 were enrolled. The X-tile program was used to determine the optimal cutoff values of CEA, FARI, and PNI. A novel combined scoring system, CEA-FARI-PNI (CFP), was constructed. The prognostic ability of these factors was assessed by the time-dependent receiver operating characteristic (ROC) curve, Kaplan-Meier, Cox regression, and logistic regression. A nomogram was established to evaluate the predictive role of CFP in tumor response.Results: The optimal cutoff values of CEA, FARI, and PNI were 5.15 ng/l, 10.56%, and 42.25 g/L, respectively. The time-dependent ROC curve showed that compared to CEA, FARI, and PNI, CFP showed stable predictive efficacy for overall survival (OS) and disease-free survival (DFS). In multivariate analysis, CFP was the only factor that could independently predict OS (HR=8.117, p=0.001) and DFS (HR=4.994, p<0.001). Moreover, high CFP (OR=3.693, p=0.002) was also an independent risk factor of poor response. The area under the ROC curve (AUC) of the nomogram for predicting TRG (tumor regression grade) was better with CFP (0.717) than without (0.656) (p<0.05).Conclusions: The CFP score is an independent prognostic factor of OS, DFS, and tumor response in LARC patients. It might be a more reliable marker for predicting the prognosis of LARC patients.