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Fibrinogen-Albumin Ratio as a New Promising Preoperative Biochemical Marker for Predicting Oncological Outcomes in Gastric Cancer: A Multi-institutional Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The systemic inflammatory response caused by host-tumor interactions is currently recognized as a hallmark feature of cancer. No study has confirmed which systemic inflammatory factors can accurately predict the progression and long-term prognosis of gastric cancer (GC).

Methods

Through the analysis of receiver operating characteristic curve (ROC), in the discovery cohort, a variety of indicators composed of usual inflammatory factors were compared. Fibrinogen-albumin ratio (FAR), which can accurately predict the long-term survival of GC patients was selected and was further verified in the test cohort and the external validation cohort.

Results

The ROC curve analysis showed that the area under curve (AUC) value of FAR on the overall survival (OS) of GC patients was higher than that of other combined markers (P < 0.01). Patients in the high FAR group showed more advanced pathological stages, larger tumor diameters, and more poorly differentiated pathological type than those in the low FAR group (P < 0.05). Logistic regression analysis elucidated that, FAR was an independent risk factor for LN metastasis and tumor invasion of GC. High FAR was an independent risk factor for poor prognosis of GC patients. The relationship between FAR and pathological stage of GC and long-term prognosis of patients was verified in the test cohort and the external validation cohort with the same FAR cutoff value. The results are consistent with those of the discovery cohort.

Conclusions

As a new developed inflammation-related marker, FAR can independently and effectively predict the tumor burden and long-term prognosis of patients with advanced GC.

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References

  1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.

    Article  CAS  Google Scholar 

  2. Jemal A, Bray F, Center MM, et al. Global cancer statistics, 2012. Ca Cancer J Clin. 2011;61:69–90.

    Article  Google Scholar 

  3. Dikken JL, Jansen EPM, Cats A, et al. Impact of the extent of surgery and postoperative chemoradiotherapy on recurrence patterns in gastric cancer. J Clin Oncol. 2010;28:2430–6.

    Article  Google Scholar 

  4. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018.

  5. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.

    Article  CAS  Google Scholar 

  6. Hanahan D et al. Hallmarks of cancer: the next generation. Cell. 2011.

  7. Diakos CI, Charles KA, Mcmillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15:e493-503.

    Article  Google Scholar 

  8. Colotta F, Allavena P et al. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009.

  9. Urabe M, Yamashita H, Seto Y. Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific survival in patients with resectable gastroesophageal junction and gastric cancer. Ann Surg. 2016;1.

  10. Hsu JT, Wang CC, Le PH, et al. Lymphocyte-to-monocyte ratios predict gastric cancer surgical outcomes. J Surg Res. 2016;284-90.

  11. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.

    Article  CAS  Google Scholar 

  12. 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. Biochim Biophys Acta Molec Cell Res. 2018;25:34.

    Google Scholar 

  13. Dolan RD, Lim J, Mcsorley ST et al. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: Systematic review and meta-analysis. Scientific Rep. 2017;7.

  14. Ross, Dolan, Stephen, et al. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017.

  15. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.

    Article  CAS  Google Scholar 

  16. Jian-Xian, Lin, Jun-Peng, et al. Prognostic value and association of sarcopenia and systemic inflammation for patients with gastric cancer following radical gastrectomy. Oncologist. 2019.

  17. You X, Zhou Q, Song J, et al. Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy. BMC Cancer. 2019; 19.

  18. Kim DK, Oh SY, Kwon HC, et al. Clinical significances of preoperative serum interleukin-6 and C-reactive protein level in operable gastric cancer. BMC Cancer. 2009;9:155.

    Article  Google Scholar 

  19. Ikeda M, Furukawa H, Imamura H, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol. 2002;9:287–91.

    Article  Google Scholar 

  20. Zhou X, Du Y, Huang Z, et al. Prognostic value of PLR in various cancers: a meta-analysis. PLoS One. 2014;9:e101119.

    Article  Google Scholar 

  21. Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13:170–6.

    Article  Google Scholar 

  22. 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;22:302–10.

    Article  Google Scholar 

  23. Takeuchi H, Ikeuchi S, Kitagawa Y, et al. Pretreatment plasma fibrinogen level correlates with tumor progression and metastasis in patients with squamous cell carcinoma of the esophagus. J Gastroenterol Hepatol. 2010;22:2222–7.

    Article  Google Scholar 

  24. Matsuda S, Takeuchi H, Fukuda K, et al. Clinical significance of plasma fibrinogen level as a predictive marker for postoperative recurrence of esophageal squamous cell carcinoma in patients receiving neoadjuvant treatment. Dis Esophagus. 654-61.

  25. Zihui, Tan, Man, et al. A novel blood tool of cancer prognosis in esophageal squamous cell carcinoma: the fibrinogen/albumin ratio. J Cancer. 2017.

  26. Yao, Liang, Wei, et al. Prognostic value of the fibrinogen/albumin ratio (FAR) in patients with operable soft tissue sarcoma. Bmc Cancer 2018.

  27. KIM, Injune, KIM, et al. Hepatic expression, synthesis and secretion of a novel fibrinogen angiopoietin-related protein that prevents endothelial-cell apoptosis. Biochem J. 2000.

  28. Sahni A, Francis CW. Vascular endothelial growth factor binds to fibrinogen and fibrin and stimulates endothelial cell proliferation. Blood. 2000;96:3772–8.

    Article  CAS  Google Scholar 

  29. Polterauer S, Seebacher V, Hefler-Frischmuth K, et al. Fibrinogen plasma levels are an independent prognostic parameter in patients with cervical cancer. Am J Obstet Gynecol. 2009;200:e641–7.

    Article  Google Scholar 

  30. 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.

  31. Brajerski W, Sikorska K, Bisztyga A, Ilenda M. Blood fibrinogen level in peptic ulcer and gastric carcinoma. Polish Med Sci Hist Bull. 1975;15:557.

    CAS  Google Scholar 

  32. Palaj J, Kečkéš Š, Marek V, et al. Fibrinogen levels are associated with lymph node involvement and overall survival in gastric cancer patients. Anticancer Res. 2018;38:1097.

    PubMed  Google Scholar 

  33. Yamamoto M, Kurokawa Y, Miyazaki Y, et al. Usefulness of preoperative plasma fibrinogen versus other prognostic markers for predicting gastric cancer recurrence. World J Surg. 2016;40:1904–9.

    Article  Google Scholar 

  34. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69.

    Article  Google Scholar 

  35. Lis CG, Gupta D, Lammersfeld CA, et al. Role of nutritional status in predicting quality of life outcomes in cancer: a systematic review of the epidemiological literature. Nutr J. 2012;11.

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Author notes

  1. Guang-Tan Lin, Yu-Bin Ma, Qi-Yue Chen contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Guang-Tan Lin MD, Qi-Yue Chen MD, Qing Zhong MD, Chao-Hui Zheng PhD, Ping Li PhD, Jian-Wei Xie PhD, Jia-Bin Wang PhD, Jian-Xian Lin PhD & Chang-Ming Huang MD

  2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China

    Guang-Tan Lin MD, Qi-Yue Chen MD, Qing Zhong MD, Chao-Hui Zheng PhD, Ping Li PhD, Jian-Wei Xie PhD, Jia-Bin Wang PhD, Jian-Xian Lin PhD & Chang-Ming Huang MD

  3. Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, 810000, China

    Yu-Bin Ma MD

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  1. Guang-Tan Lin MD
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Contributions

Conception/Design: CMH, CHZ, GTL, QYC. Provision of study material or patients: GTL, YBM, QYC, QZ, CHZ, PL, JWX, JBW, JXL, CMH. Collection and/or assembly of data: QYC, QZ, GTL, PL, JWX, JBW, JXL. Data analysis and interpretation: GTL, QYC. Manuscript writing: GTL, QYC, YBM, CHZ, CMH. Final approval of manuscript: GTL, YBM, QYC, QZ, CHZ, PL, JWX, JBW, JXL, CMH.

Corresponding author

Correspondence to Chang-Ming Huang MD.

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Supported by Scientific and technological innovation joint capital projects of Fujian Province (2017Y9011, 2017Y9004, 2018Y9041); Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171); The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013); The general project of sailing fund of Fujian Medical University (2019QH1052).

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Lin, GT., Ma, YB., Chen, QY. et al. Fibrinogen-Albumin Ratio as a New Promising Preoperative Biochemical Marker for Predicting Oncological Outcomes in Gastric Cancer: A Multi-institutional Study. Ann Surg Oncol 28, 7063–7073 (2021). https://doi.org/10.1245/s10434-021-10027-9

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  • DOI: https://doi.org/10.1245/s10434-021-10027-9

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