Prognostic value of fibrinogen‑to‑albumin ratio in patients with gastric cancer receiving first‑line chemotherapy
Authors: Fang Li
Qian Dong
Feifei Bi
Zhuo Wang
Zhiyan Zhang
Qiwei Wang
Jiawen Xiao
Haijing Li
Jingdong Zhang
Yuanhe Wang
Liqun Zhang
Haiyan Piao
Journal: Oncology Letters (2020)
Discipline: CLINICAL MEDICINE
Keywords: fibrinogen-to-albumin ratio; first-line chemotherapy; gastric cancer; overall survival; prognosis
Affiliations: Medical Oncology Department of Gastrointestinal Cancer, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, Liaoning 110042, P.R. China, Department of Medical Oncology, Shenyang Fifth People's Hospital, Shenyang, Liaoning 110020, P.R. China, Department of Hepatobiliary Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, Liaoning 110042, P.R. China

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 cut-off values determined by receiver operating characteristic (ROC) analysis, the patients were divided into low-FAR (≤10.03) and high-FAR (&gt;10.03), low-fibrinogen (&lt;3.8 g/l) and high-fibrinogen (≥3.8 g/l), and low-albumin (&lt;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&lt;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&lt;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&lt;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&lt;0.05), and may also reliably identify patients with poor prognosis among those with normal fibrinogen and albumin levels (all P&lt;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. 

Retracted: No

PubPeer comments:
 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),. The Multivariate analysis results in the table showed P 0.001. ![file] 2.The abstract saysuff0c A high FAR was significantly associated with a more advanced stage, peritoneal metastasis, Increased CA72u20104 levels and CIA;0.05). The cut-off value is set to 115, which is inconsistent with the anemia guidelines. ,