Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107980
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107980
Impact of fibrinogen-to-albumin ratio on the long-term prognosis of patients with advanced HER2-negative gastric cancer receiving immunochemotherapy
Zhi-Yuan Yao, Jie Liu, Xiao Ma, Wan-Ting Li, Yu Shen, Yong-Zheng Cui, Yan Fang, Zheng-Xiang Han, Chun-Hua Yang
Zhi-Yuan Yao, Zheng-Xiang Han, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Jie Liu, Wan-Ting Li, Yu Shen, Yong-Zheng Cui, Chun-Hua Yang, Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Xiao Ma, Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Yan Fang, Department of Gastroenterology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
Co-first authors: Zhi-Yuan Yao and Jie Liu.
Co-corresponding authors: Zheng-Xiang Han and Chun-Hua Yang.
Author contributions: Yao ZY, Liu J, Han ZX, and Yang CH contributed to the conceptualization, writing-review and editing of this manuscript; Yao ZY and Yang CH were responsible for the methodology of this study; Yao ZY contributed to the formal analysis of this manuscript and the visualization of this article; Yao ZY, Liu J, Ma X, Li WT and Shen Y took part in the writing-original draft and investigation of this manuscript; Yao ZY, Han ZX and Yang CH contributed to the project administration and the supervision of this manuscript; Liu J, Ma X, Li WT, Shen Y and Fang Y took part in the data curation of this study; Yao ZY and Liu J were responsible for the validation of this manuscript; Shen Y and Cui YZ took part in the resources; Han ZX and Yang CH were involved in the supervision of this study; Yao ZY and Liu J contributed equally to the manuscript, they are co-first authors of this manuscript. Han ZX and Yang CH contributed to this manuscript equally, they are co-corresponding authors of this study.
Institutional review board statement: This research was carried out following the Declaration of Helsinki and received approval from the Ethics Committee at the Affiliated Hospital of Xuzhou Medical University (approval No. XYFY2023-KL277-01).
Informed consent statement: Given the retrospective design of this investigation, the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University granted us an exemption from obtaining written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data included in this study can be obtained from the corresponding author at 13063518075@126.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Hua Yang, MD, PhD, Professor, Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221000, Jiangsu Province, China. 13063518075@126.com
Received: April 2, 2025
Revised: April 17, 2025
Accepted: May 13, 2025
Published online: June 15, 2025
Processing time: 72 Days and 11.8 Hours
Abstract
BACKGROUND

There is currently no effective targeted therapy for advanced HER2-negative gastric cancer (GC). While immunotherapy combined with chemotherapy is the first-line treatment for GC, patient survival outcomes remain highly heterogeneous, highlighting the urgent need for reliable predictive biomarkers. The fibrinogen-to-albumin ratio (FAR) integrates both inflammation (elevated fibrinogen levels) and nutritional status (reduced albumin levels). Although FAR has been associated with immunotherapy resistance in various solid tumors, its prognostic value in GC patients receiving immunochemotherapy remains unclear.

AIM

To assess the predictive value of the FAR in the long-term prognosis of advanced HER2-negative GC patients receiving sintilimab-based immunotherapy combined with chemotherapy.

METHODS

This retrospective study included 260 patients with unresectable or metastatic HER2-negative GC who received sintilimab plus chemotherapy from 2021 to 2024. Pre-treatment FAR values were calculated, and the optimal cutoff value was determined using receiver operating characteristic curve analysis. The association between the FAR and overall survival (OS) and progression-free survival (PFS) was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models. Independent prognostic factors were identified by multivariate Cox regression analysis based on OS, and a nomogram model was constructed incorporating FAR. The concordance index (C-index) and calibration curves were used to assess the predictive performance and calibration of the model.

RESULTS

Patients with high FAR (≥ 0.08) had significantly shorter median PFS [7.80 months (6.40-8.30) vs 10.00 months (9.30-11.20), P < 0.001] and OS [14.20 months (12.20-16.60) vs 19.50 months (18.80-22.00), P < 0.001] compared to the group with low FAR (< 0.08). Moreover, the group with high FAR had a significantly lower objective response rate (10.22% vs 19.51%, P = 0.034) and disease control rate (34.31% vs 49.59%, P = 0.013). The incidence of adverse events did not significantly differ between the two groups (P > 0.05). Multivariate analysis confirmed the FAR as an independent prognostic factor for OS (HR = 2.33, 95%CI: 1.59-3.43, P < 0.001). The nomogram model, incorporating FAR, Eastern Cooperative Oncology Group performance status, programmed cell death ligand 1 expression, tumor stage, and body mass index, demonstrated strong predictive accuracy, with an internal validation C-index of 0.73 (95%CI: 0.66-0.79). The calibration curve showed a high consistency between predicted and actual survival rates.

CONCLUSION

Patients with low FAR had significantly better prognostic outcomes than those with high FAR when receiving immunochemotherapy. Thus, FAR may serve as a valuable prognostic biomarker for predicting survival outcomes in patients with advanced HER2-negative GC.

Keywords: Gastric cancer; HER2-negative gastric cancer; Programmed death-1 inhibitor; Predictive model; Efficacy; Safety

Core Tip: This study is the first to validate the prognostic value of the fibrinogen-to-albumin ratio (FAR) in advanced HER2-negative gastric cancer patients receiving immunochemotherapy. High FAR was significantly associated with shorter progression-free survival and overall survival, establishing FAR as an independent prognostic factor. The predictive model incorporating FAR allows for personalized survival predictions, offering a valuable and cost-effective tool for clinical decision-making. These findings underscore FAR's potential as a practical biomarker for guiding treatment strategies in advanced gastric cancer.