Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2018; 24(29): 3281-3292
Published online Aug 7, 2018. doi: 10.3748/wjg.v24.i29.3281
Prognostic significance of the fibrinogen-to-albumin ratio in gallbladder cancer patients
Wei-Yu Xu, Hao-Hai Zhang, Jian-Ping Xiong, Xiao-Bo Yang, Yi Bai, Jian-Zhen Lin, Jun-Yu Long, Yong-Chang Zheng, Hai-Tao Zhao, Xin-Ting Sang
Wei-Yu Xu, Hao-Hai Zhang, Jian-Ping Xiong, Xiao-Bo Yang, Yi Bai, Jian-Zhen Lin, Jun-Yu Long, Yong-Chang Zheng, Hai-Tao Zhao, Xin-Ting Sang, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Xu WY conceived the research, collected the clinical data and wrote the manuscript that led to the submission; Xu WY, Zhang HH, and Xiong JP helped to collect the clinical data and followed up with the patients; Lin JZ, Long JY, and Yang XB helped to analyze the data, Bai Y and Zheng YC revised the manuscript, Zhao HT and Sang XT provided financial support for this work; Zhao HT and Sang XT are co-corresponding authors, and they contributed equally to this work; all authors read and approved the final manuscript.
Supported by the National Key Project Research and Development Projects, No. S2016G9012; International Science and Technology Cooperation Projects, No. 2015DFA30650; and The Capital Special Research Project for Clinical Application, No. Z151100004015170.
Institutional review board statement: The publication of this manuscript has been reviewed and approved by the PUMCH Institutional Review Board.
Informed consent statement: All patients and their families signed informed consent statements before surgery, and the type of surgical procedure was performed according to the approved guidelines.
Conflict-of-interest statement: We declare that the authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xin-Ting Sang, MD, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. sangxt@pumch.cn.
Telephone: +86-10-69156042 Fax:+86-10-69156042
Received: April 20, 2018
Peer-review started: April 20, 2018
First decision: June 6, 2018
Revised: June 16, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: August 7, 2018
Abstract
AIM

To investigate the prognostic role of fibrinogen-to-albumin ratio (FAR) on patients with gallbladder cancer (GBC) in this study.

METHODS

One hundred and fifty-four GBC patients were retrospectively analyzed, who received potentially curative cholecystectomy in our institute from March 2005 to December 2017. Receiver operating characteristic curve (ROC curve) was used to determine the optimal cut-offs for these biomarkers. In addition, Kaplan-Meier survival analysis as well as multivariate analysis were applied for prognostic analyses.

RESULTS

ROC curve revealed that the optimal cut-off value for FAR was 0.08. FAR was significantly correlated with age (P = 0.045), jaundice (P < 0.001), differentiation (P = 0.002), resection margin status (P < 0.001), T stage (P < 0.001), TNM stage (P < 0.001), and CA199 (P < 0.001) as well as albumin levels (P < 0.001). Multivariate analysis indicated that the resection margin status [hazard ratio (HR): 2.343, 95% confidence interval (CI): 1.532-3.581, P < 0.001], TNM stage (P = 0.035), albumin level (HR = 0.595, 95%CI: 0.385-0.921, P = 0.020) and FAR (HR: 2.813, 95%CI: 1.765-4.484, P < 0.001) were independent prognostic factors in GBC patients.

CONCLUSION

An elevated preoperative FAR was significantly correlated with unfavorable overall survival in GBC patients, while an elevated preoperative albumin level was a protective prognostic factor for patients with GBC. The preoperative FAR could be used to predict the prognosis of GBC patients, which was easily accessible, cost-effective and noninvasive.

Keywords: Gallbladder cancer, Fibrinogen, Albumin, Fibrinogen-to-albumin ratio, Prognosis, Survival

Core tip: The vital prognostic significance of fibrinogen and serum albumin has been confirmed in diverse malignancies, presenting host hemostasis and nutrition, respectively. Moreover, elevated plasma fibrinogen and reduced serum albumin levels are significantly related to shortened survival of cancer patients. It is reported that fibrinogen-to-albumin ratio (FAR) is more potent in predicting cancer patient prognosis than elevated fibrinogen or reduced serum albumin level alone. Nevertheless, there has been no study on the prognostic role of FAR in gallbladder cancer (GBC). Herein, we defined an elevated preoperative FAR, featured by noninvasiveness, cost-effectiveness and easily-accessible, which was a potential prognostic indicator for GBC.