Inflammation and nutrition are two main causes contributing to progression of gastric cancer (GC), and inflammatory biomarker may be presented as its valuable prognostic factor. Thus, this study was carried out to investigate the prognostic significance of preoperative circulating albumin/fibrinogen ratio (AFR), fibrinogen/pre-Albumin ratio (FPR), fibrinogen (Fib), albumin (Alb) and pre-Albumin (pAlb) in surgical GC.
Materials and Methods: Three hundred and sixty surgical stage II and III GC patients from June 2011 to December 2013 were enrolled in this retrospective study. X-tile software, Kaplan-Meier curve and Cox regression model were used to evaluate the prognostic role of them. A predictive nomogram was established to predict prognosis of overall survival (OS), and its accuracy was assessed by concordance index (c-index).
Decreased Alb (adjusted HR = 1.614, 95%CI=1.103-2.361), pAlb (adjusted HR = 2.111, 95%CI=1.437-3.100), AFR (adjusted HR = 1.540, 95%CI=1.013-2.343) and elevated FPR (adjusted HR = 2.325, 95%CI=1.372-3.940) were significantly associated with shorter OS. FPR was identified as the most effective prognostic factor to predict 3-year’s OS by identified as the most effective prognostic factor to predict 3-year’s OS by time-dependent ROC analysis. A long survival was observed in stage II (P = 0.007) and III (P = 0.002) GC patients with low level of FPR comparing to the patients with high FPR, and the prognosis of III stage FPR-low GC patients undergoing adjuvant chemotherapy was significantly superior to the patients without the treatment (P = 0.002). However, no difference of survival was examined in II stage subgroups stratified by FPR and high FRP of III stage patients with or not the treatment of adjuvant chemotherapy. C-index of nomogram containing FPR (c-index=0.756) was high in comparison with the nomogram without FPR (c-index =0.748).
Preoperative FPR might be a feasible prognostic biomarker in surgical stage II and III GC patients and it could precisely distinguish stage III patients who appeared to benefit from adjuvant chemotherapy. Meanwhile established nomogram based on clinical parameters and FPR could improve its predictive efficacy in 3 years’ OS.
Clinical trial identification
Legal entity responsible for the study
The study was approved by the Ethical Committee of the Second Affiliated Hospital of Nanchang University.
All authors have declared no conflicts of interest.