Xu WY, Zhang HH, Xiong JP, Yang XB, Bai Y, Lin JZ, Long JY, Zheng YC, Zhao HT, Sang XT. Prognostic significance of the fibrinogen-to-albumin ratio in gallbladder cancer patients. World J Gastroenterol 2018; 24(29): 3281-3292 [PMID: 30090008 DOI: 10.3748/wjg.v24.i29.3281]
Corresponding Author of This Article
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.
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Aug 7, 2018; 24(29): 3281-3292 Published online Aug 7, 2018. doi: 10.3748/wjg.v24.i29.3281
Table 1 Baseline characteristics of 154 gallbladder cancer patients who underwent potential curative cholecystectomy n (%)
Characteristic
Patients (n = 154)
Age (yr)
64 (29-85)
≤ 60
56 (36.4)
> 60
98 (63.6)
Sex
Male
63 (40.9)
Female
91 (59.1)
Cholecystolithiasis
Absent
79 (51.3)
Present
75 (48.7)
Diabetes
Absent
116 (75.3)
Present
38 (24.7)
Jaundice
Absent
129 (83.8)
Present
25 (8.9)
Blood groups
A
43 (27.9)
B
56 (36.4)
AB
9 (5.8)
O
46 (29.9)
Pathological types
Adenosquamous carcinoma
3 (1.9)
Adenocarcinoma
150 (97.4)
Papillocarcinoma
1 (0.6)
Degree of differentiation
Poor
60 (39.0)
Moderate-well
94 (61.0)
Resection margin status
Negative
96 (62.3)
Positive
58 (37.7)
Maximum tumor diameter (cm)
3 (0.2-13)
≤ 2.45
68 (44.2)
> 2.45
86 (55.8)
T stage
Tis-T1a
10 (6.5)
T1b-T2b
29 (18.8)
T3
103 (66.9)
T4
12 (7.8)
N stage
0
98 (63.6)
1
47 (30.5)
2
9 (5.8)
Distant metastasis
Absent
142 (92.2)
Present
12 (7.8)
TNM stage
0-Istage
16 (10.4)
IIA-IIB stage
16 (10.4)
IIIA-IIIB stage
92 (59.7)
IVA-IVB stage
30 (19.5)
CA199 (U/mL)
69.3 (0.6-10524)
≤ 39
66 (42.9)
> 39
88 (57.1)
Fibrinogen concentration (g/L)
3.54 (1.71-7.47)
≤ 3.47
75 (48.7)
> 3.47
79 (51.3)
Albumin levels (g/L)
41.0 (20.0-50.0)
≤ 40.5
78 (50.6)
> 40.5
76 (49.4)
FAR
0.09 (0.04-0.25)
≤ 0.08
71 (46.1)
> 0.08
83 (53.9)
Table 2 Correlation between fibrinogen concentration and clinicopathological characteristics in gallbladder cancer patients n (%)
Characteristics
Fibrinogen concentration
P value
≤ 3.47 g/L (n = 75)
> 3.47 g/L (n = 79)
Age (yr)
≤ 60
31 (20.1)
25 (16.2)
0.243
> 60
44 (28.6)
54 (35.1)
Sex
Male
33 (21.4)
30 (19.5)
0.513
Female
42 (27.3)
49 (31.8)
Cholecystolithiasis
Absent
38 (24.7)
41 (26.6)
0.878
Present
37 (24.0)
38 (24.7)
Diabetes
Absent
57 (37.0)
59 (38.3)
0.850
Present
18 (11.7)
20 (13.0)
Jaundice
Absent
68 (44.2)
61 (39.6)
0.029
Present
7 (4.5)
18 (11.7)
Blood groups
A
19 (12.3)
24 (15.6)
0.145
B
33 (21.4)
23 (14.9)
AB
2 (1.3)
7 (4.5)
O
21 (13.6)
25 (16.2)
Pathological types
Adenosquamous carcinoma
0 (0)
3 (1.9)
0.142
Adenocarcinoma
75 (48.7)
75 (48.7)
Papillocarcinoma
0 (0)
1 (0.6)
Degree of differentiation
Poor
23 (14.9)
37 (24.0)
0.048
Moderate-well
52 (33.8)
42 (27.3)
Resection margin status
Negative
56 (36.4)
40 (26.4)
0.003
Positive
19 (12.3)
39 (25.3)
Maximum tumor diameter (cm)
≤ 2.45
34 (22.1)
34 (22.1)
0.871
> 2.45
41 (26.6)
45 (29.2)
T stage
Tis-T1a
8 (5.2)
2 (1.3)
< 0.001
T1b-T2b
22 (14.3)
7 (4.5)
T3
43 (27.9)
60 (39.0)
T4
2 (1.3)
10 (6.5)
N stage
N0
50 (32.5)
48 (31.2)
0.748
N1
21 (13.6)
26 (16.9)
N2
4 (2.6)
5 (3.2)
Distant metastasis
Absent
69 (44.8)
73 (47.4)
0.925
Present
6 (3.9)
6 (3.9)
TNM stage
0-Istage
12 (7.8)
4 (2.6)
0.011
IIA-IIB stage
12 (7.8)
4 (2.6)
IIIA-IIIB stage
39 (25.3)
53 (34.4)
IVA-IVB stage
12 (7.8)
18 (11.7)
CA199 (U/mL)
≤ 39
41 (26.6)
25 (16.2)
0.005
> 39
34 (22.1)
54 (35.1)
Albumin levels (g/L)
≤ 40.5
32 (20.8)
44 (28.6)
0.111
> 40.5
43 (27.9)
35 (22.7)
FAR
≤ 0.08
59 (38.3)
12 (7.8)
< 0.001
> 0.08
16 (10.4)
67 (43.5)
Table 3 Correlation between albumin levels and clinicopathological characteristics in gallbladder cancer patients n (%)
Characteristics
Albumin levels
P value
≤ 40.5g/L(n = 76)
> 40.5 g/L(n = 78)
Age (yr)
≤ 60
22 (14.3)
34 (22.1)
0.067
> 60
54 (35.1)
44 (28.6)
Sex
Male
28 (18.2)
35 (22.7)
0.330
Female
48 (31.2)
43 (27.9)
Cholecystolithiasis
Absent
34 (22.1)
45 (29.2)
0.147
Present
42 (27.3)
33 (21.4)
Diabetes
Absent
53 (34.4)
63 (40.9)
0.136
Present
23 (14.9)
15 (9.7)
Jaundice
Absent
54 (35.1)
75 (48.7)
< 0.001
Present
22 (14.3)
3 (1.9)
Blood groups
A
20 (13.0)
23 (14.9)
0.046
B
34 (22.1)
22 (14.3)
AB
6 (7.9)
3 (3.8)
O
16 (21.1)
30 (19.5)
Pathological types
Adenosquamous carcinoma
0 (0)
3 (1.9)
0.137
Adenocarcinoma
75 (48.7)
75 (48.7)
Papillocarcinoma
1 (0.6)
0 (0.0)
Degree of differentiation
Poor
36 (23.4)
24 (15.6)
0.047
Moderate-well
40 (26.0)
54 (35.1)
Resection margin status
Negative
39 (25.3)
57 (37.0)
0.008
Positive
37 (24.0)
21 (13.6)
Maximum tumor diameter (cm)
≤ 2.45
36 (23.4)
32 (20.8)
0.516
> 2.45
40 (26.0)
46 (29.9)
T stage
Tis-T1a
2 (1.3)
8 (5.2)
0.021
T1b-T2b
9 (5.8)
20 (13.0)
T3
58 (37.7)
45 (29.2)
T4
7 (4.5)
5 (3.2)
N stage
N0
45 (29.2)
53 (34.4)
0.403
N1
25 (16.2)
22 (14.3)
N2
6 (3.9)
3 (1.9)
Distant metastasis
Absent
67 (43.5)
75 (48.7)
0.077
Present
9 (5.8)
3 (1.9)
TNM stage
0-Istage
3 (1.9)
13 (8.4)
0.007
IIA-IIB stage
6 (3.9)
10 (6.5)
IIIA-IIIB stage
46 (29.9)
46 (29.9)
IVA-IVB stage
21 (13.6)
9 (5.8)
CA199 (U/mL)
≤ 39
24 (15.6)
42 (27.3)
0.006
> 39
52 (33.8)
36 (23.4)
Fibrinogen concentration (g/L)
0.111
≤ 3.47g/L
32 (20.8)
43 (27.9)
> 3.47 g/L
44 (28.6)
35 (22.7)
FAR
≤ 0.08
21 (13.6)
50 (32.5)
< 0.001
> 0.08
55 (35.7)
28 (18.2)
Table 4 Correlation between FAR and clinicopathological characteristics in gallbladder cancer patients n (%)
Characteristics
FAR
P value
≤ 0.08(n = 71)
> 0.08(n = 83)
Age (yr)
≤ 60
32 (20.8)
24 (15.6)
0.045
> 60
39 (25.3)
59 (38.3)
Sex
Male
30 (19.5)
33 (21.4)
0.870
Female
41 (26.6)
50 (32.5)
Cholecystolithiasis
Absent
37 (24.0)
42 (27.3)
0.873
Present
34 (22.1)
41 (26.6)
Diabetes
Absent
56 (36.4)
60 (39.0)
0.357
Present
15 (9.7)
23 (14.9)
Jaundice
Absent
67 (43.5)
62 (40.3)
< 0.001
Present
4 (2.6)
21 (13.6)
Blood groups
A
22 (14.3)
21 (13.6)
0.148
B
28 (18.2)
28 (18.2)
AB
1 (0.6)
8 (5.2)
O
20 (13.0)
26 (16.9)
Pathological types
Adenosquamous carcinoma
0 (0)
3 (1.9)
0.173
Adenocarcinoma
71 (46.1)
79 (51.3)
Papillocarcinoma
0 (0)
1 (0.6)
Degree of differentiation
Poor
18 (11.7)
42 (27.3)
0.002
Moderate-well
53 (34.4)
41 (26.6)
Resection margin status
Negative
55 (35.7)
41 (26.6)
< 0.001
Positive
16 (10.4)
42 (27.3)
Maximum tumor diameter (cm)
≤ 2.45
37 (24.0)
31 (20.1)
0.075
> 2.45
34 (22.1)
52 (33.8)
T stage
Tis-T1a
8 (5.2)
2 (1.3)
< 0.001
T1b-T2b
24 (15.6)
5 (3.2)
T3
36 (23.4)
67 (43.5)
T4
3 (1.9)
9 (5.8)
N stage
N0
48 (31.2)
50 (32.5)
0.623
N1
19 (12.3)
28 (18.2)
N2
4 (2.6)
5 (3.2)
Distant metastasis
Absent
68 (44.2)
74 (48.1)
0.145
Present
3 (1.9)
9 (5.8)
TNM stage
0-Istage
14 (9.1)
2 (1.3)
< 0.001
IIA-IIB stage
14 (9.1)
2 (1.3)
IIIA-IIIB stage
35 (22.7)
57 (37.0)
IVA-IVB stage
8 (5.2)
22 (14.3)
CA199 (U/mL)
≤ 39
43 (27.9)
23 (14.9)
< 0.001
> 39
28 (18.2)
60 (39.0)
Fibrinogen concentration (g/L)
≤ 3.47g/L
59 (38.3)
16 (10.4)
< 0.001
> 3.47 g/L
12 (7.8)
67 (43.5)
Albumin levels (g/L)
≤ 40.5g/L
21 (13.6)
55 (35.7)
< 0.001
> 40.5 g/L
50 (32.5)
28 (18.2)
Table 5 Univariate analysis of overall survival in gallbladder cancer patients
Characteristics
HR (95%CI)
P value
Age (yr)
1.473 (0.973-2.230)
0.067
≤ 60
> 60
Sex
0.995 (0.670-1.477)
0.981
Male
Female
Cholecystolithiasis
1.198 (0.814-1.764)
0.360
Absent
Present
Diabetes
1.028 (0.651-1.623)
0.906
Absent
Present
Jaundice
2.598 (1.644-4.106)
< 0.001
Absent
Present
Blood groups
-
0.113
A
B
AB
O
Pathological types
-
0.165
Adenosquamous carcinoma
Adenocarcinoma
Papillocarcinoma
Degree of differentiation
1.527 (1.031-2.261)
0.035
Poor
Moderate-well
Resection margin status
3.683 (2.468-5.496)
< 0.001
Negative
Positive
Maximum tumor diameter (cm)
1.101 (0.744-1.630)
0.631
≤ 2.45
> 2.45
T stage
-
< 0.001
Tis-T1a
T1b-T2b
T3
T4
N stage
-
< 0.001
0
1
2
Distant metastasis
2.550 (1.388-4.684)
0.003
Absent
Present
TNM stage
-
< 0.001
0-Istage
IIA-IIB stage
IIIA-IIIB stage
IVA-IVB stage
CA199 (U/mL)
3.125 (2.010-4.858)
< 0.001
≤ 39
> 39
Fibrinogen concentration (g/L)
2.795 (1.853-4.214)
< 0.001
≤ 3.47
> 3.47
Albumin levels (g/L)
0.391(0.259-0.590)
< 0.001
≤ 40.5
> 40.5
FAR
4.626(2.987-7.165)
< 0.001
≤ 0.08
> 0.08
Table 6 Multivariate analysis for overall survival in gallbladder cancer patients
Characteristics
HR (95%CI)
Wald
P value
Resection margin status
2.343 (1.532-3.581)
< 0.001
Negative
Positive
TNM stage
8.595
0.035
IIA-IIB stage/0-1stage
1.209 (0.287-5.095)
0.067
0.796
IIIA-IIIB stage/0-1 stage
3.401 (1.033-11.202)
4.051
0.044
IVA-IVB stage/0-1 stage
4.014 (1.142-14.107)
4.696
0.030
FAR
2.813 (1.765-4.484)
< 0.001
≤ 0.08
> 0.08
Albumin levels (g/L)
0.595 (0.385-0.921)
0.020
≤ 40.5
> 40.5
Citation: Xu WY, Zhang HH, Xiong JP, Yang XB, Bai Y, Lin JZ, Long JY, Zheng YC, Zhao HT, Sang XT. Prognostic significance of the fibrinogen-to-albumin ratio in gallbladder cancer patients. World J Gastroenterol 2018; 24(29): 3281-3292