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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3682–3692 | Cite as

Fibrinogen–Albumin Ratio Index (FARI): A More Promising Inflammation-Based Prognostic Marker for Patients Undergoing Hepatectomy for Colorectal Liver Metastases

  • Yan-Yan Wang
  • Zhen-Zhen Liu
  • Da Xu
  • Ming Liu
  • Kun Wang
  • Bao-Cai XingEmail author
Hepatobiliary Tumors
  • 172 Downloads

Abstract

Background

Systemic inflammation response is involved in the development and progression of cancers. This study aimed to evaluate the prognostic value of a preoperative Fibrinogen–Albumin Ratio Index (FARI) in patients undergoing hepatectomy for colorectal liver metastases (CRLM) and compare it with established systemic inflammation markers, including the neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, platelet–lymphocyte ratio, and systemic immune–inflammation index.

Methods

Patients who underwent hepatectomy for CRLM between November 2002 and December 2016 were considered for inclusion. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of markers in predicting survival. Multivariable Cox regression analysis was used to identify independent predictors for overall survival (OS) or disease-free survival (DFS).

Results

A total of 452 consecutive patients were enrolled. The areas under the ROC curve of the FARI in predicting OS and DFS were superior to other inflammatory markers and carcinoembryonic antigen (CEA). The optimal cut-off value of the FARI was 7.6%. Patients with a high FARI (> 7.6%) showed significantly decreased OS and DFS (all p < 0.001). In multivariable analysis, the FARI was the only inflammatory marker that independently predicted OS and DFS. Additionally, regardless of patients having a high or low CEA, the FARI further stratified these patients into subgroups with significantly distinct OS and DFS (all p < 0.05). The FARI also showed good clinical utility in patients with different clinical characteristics.

Conclusions

A preoperative FARI is an independent predictor of OS and DFS for patients undergoing hepatectomy for CRLM, superior to the established systemic inflammation markers and CEA.

Notes

Funding

This study was supported by grants from the Chinese State Key Project for Basic Research (973) [2014CBA02001].

Disclosure

Yan-Yan Wang, Zhen-Zhen Liu, Da Xu, Ming Liu, Kun Wang, and Bao-Cai Xing declare no conflicts of interest.

Supplementary material

10434_2019_7586_MOESM1_ESM.docx (2.5 mb)
Supplementary material 1 (DOCX 2529 kb)

References

  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRefPubMedGoogle Scholar
  2. 2.
    Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jones RP, Kokudo N, Folprecht G, et al. Colorectal liver metastases: a critical review of state of the art. Liver Cancer. 2016;6(1):66–71.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Van Cutsem E, Cervantes A, Nordlinger B, Arnold D. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii1–9.Google Scholar
  5. 5.
    Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg. 2010;97(7):1110–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Hallet J, Sa Cunha A, Adam R, et al. Factors influencing recurrence following initial hepatectomy for colorectal liver metastases. Br J Surg. 2016;103(10):1366–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15(11):e493–503.CrossRefGoogle Scholar
  8. 8.
    Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883–99.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44.CrossRefGoogle Scholar
  10. 10.
    Dolan RD, McSorley ST, Park JH, et al. The prognostic value of systemic inflammation in patients undergoing surgery for colon cancer: comparison of composite ratios and cumulative scores. Br J Cancer. 2018;119(1):40–51.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hu B, Yang XR, Xu Y, et al. Systemic immune–inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22.CrossRefGoogle Scholar
  12. 12.
    Jagadesham VP, Lagarde SM, Immanuel A, Griffin SM. Systemic inflammatory markers and outcome in patients with locally advanced adenocarcinoma of the oesophagus and gastro-oesophageal junction. Br J Surg. 2017;104(4):401–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Cannon NA, Meyer J, Iyengar P, et al. Neutrophil-lymphocyte and platelet–lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. J Thorac Oncol. 2015;10(2):280–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Chan JC, Chan DL, Diakos CI, et al. The lymphocyte-to-monocyte ratio is a superior predictor of overall survival in comparison to established biomarkers of resectable colorectal cancer. Ann Surg. 2017;265(3):539–46.CrossRefPubMedGoogle Scholar
  15. 15.
    Araujo RL, Gonen M, Herman P. Chemotherapy for patients with colorectal liver metastases who underwent curative resection improves long-term outcomes: systematic review and meta-analysis. Ann Surg Oncol. 2015;22(9):3070–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Yoshino T, Arnold D, Taniguchi H, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol. 2018;29(1):44–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371(9617):1007–16.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16(3):614–22.CrossRefPubMedGoogle Scholar
  19. 19.
    Neal CP, Mann CD, Garcea G, Briggs CD, Dennison AR, Berry DP. Preoperative systemic inflammation and infectious complications after resection of colorectal liver metastases. Arch Surg. 2011;146(4):471–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47(17):2633–41.Google Scholar
  21. 21.
    Ghanim B, Hoda MA, Klikovits T, et al. Circulating fibrinogen is a prognostic and predictive biomarker in malignant pleural mesothelioma. Br J Cancer. 2014;110(4):984–90.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Seebacher V, Polterauer S, Grimm C, et al. The prognostic value of plasma fibrinogen levels in patients with endometrial cancer: a multi-centre trial. Br J Cancer. 2010;102(6):952–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Polterauer S, Grimm C, Seebacher V, et al. Plasma fibrinogen levels and prognosis in patients with ovarian cancer: a multicenter study. Oncologist. 2009;14(10):979–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Aggarwal C, Meropol NJ, Punt CJ, et al. Relationship among circulating tumor cells, CEA and overall survival in patients with metastatic colorectal cancer. Ann Oncol. 2013;24(2):420–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 18–21.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Imai K, Allard MA, Castro Benitez C, et al. Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg. 2017;104(5):570–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Ruers T, Punt C, Van Coevorden F, et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004). Ann Oncol. 2012;23(10):2619–26.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Wang K, Xu D, Yan XL, Poston G, Xing BC. The impact of primary tumour location in patients undergoing hepatic resection for colorectal liver metastasis. Eur J Surg Oncol. 2018;44(6):771–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Blanche P, Dartigues JF, Jacqmin-Gadda H. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med. 2013;32(30):5381–97.CrossRefPubMedGoogle Scholar
  30. 30.
    Camp RL, Dolled-Filhart M, Rimm DL. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res. 2004;10(21):7252–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Pine JK, Morris E, Hutchins GG, et al. Systemic neutrophil-to-lymphocyte ratio in colorectal cancer: the relationship to patient survival, tumour biology and local lymphocytic response to tumour. Br J Cancer. 2015;113(2):204–11.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Wang YY, Zhong JH, Su ZY, et al. Albumin–bilirubin versus Child–Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg. 2016;103(6):725–34.CrossRefGoogle Scholar
  33. 33.
    Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune–inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23(34):6261–72.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Matsuda S, Takeuchi H, Kawakubo H, et al. Cumulative prognostic scores based on plasma fibrinogen and serum albumin levels in esophageal cancer patients treated with transthoracic esophagectomy: comparison with the Glasgow prognostic score. Ann Surg Oncol. 2015;22(1):302–10.CrossRefPubMedGoogle Scholar
  35. 35.
    Xu Q, Yan Y, Gu S, et al. A novel inflammation-based prognostic score: the fibrinogen/albumin ratio predicts prognoses of patients after curative resection for hepatocellular carcinoma. J Immunol Res. 2018;2018:4925498.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Giakoustidis A, Neofytou K, Khan AZ, Mudan S. Neutrophil to lymphocyte ratio predicts pattern of recurrence in patients undergoing liver resection for colorectal liver metastasis and thus the overall survival. J Surg Oncol. 2015;111(4):445–50.CrossRefPubMedGoogle Scholar
  37. 37.
    Neofytou K, Smyth EC, Giakoustidis A, Khan AZ, Cunningham D, Mudan S. Elevated platelet to lymphocyte ratio predicts poor prognosis after hepatectomy for liver-only colorectal metastases, and it is superior to neutrophil to lymphocyte ratio as an adverse prognostic factor. Med Oncol. 2014;31(10):239.CrossRefPubMedGoogle Scholar
  38. 38.
    Margonis GA, Sasaki K, Gholami S, et al. Genetic and morphological evaluation (GAME) score for patients with colorectal liver metastases. Br J Surg. 2018;105(9):1210–20.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yan-Yan Wang
    • 1
  • Zhen-Zhen Liu
    • 1
  • Da Xu
    • 1
  • Ming Liu
    • 1
  • Kun Wang
    • 1
  • Bao-Cai Xing
    • 1
    Email author
  1. 1.Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of OncologyBeijing Cancer Hospital and InstituteHaidian District, BeijingChina

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