Impact of fibrinogen-to-albumin ratio on the long-term prognosis of patients with advanced HER2-negative gastric cancer receiving immunochemotherapy

doi:10.4251/wjgo.v17.i6.107980

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107980
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107980

Table 1 Baseline characteristics of fibrinogen to albumin ratio < 0.08 and fibrinogen to albumin ratio ≥ 0.08, n (%)

Variables	Overall, mean ± SD/n (%), n = 260	Low FAR, mean ± SD/n (%), n = 123	High FAR, mean ± SD/n (%), n = 137	P value
Fibrinogen, g/L	3.63 ± 0.91	2.91 ± 0.55	4.27 ± 0.66	< 0.001
Albumin, g/L	40.24 ± 4.86	42.30 ± 4.48	38.40 ± 4.43	< 0.001
FAR	0.09 ± 0.03	0.07 ± 0.01	0.11 ± 0.02	< 0.001
Sex				0.799
Female	129 (49.62)	60 (48.78)	69 (50.36)
Male	131 (50.38)	63 (51.22)	68 (49.64)
Age, years				0.861
< 60	119 (45.77)	57 (46.34)	62 (45.26)
≥ 60	141 (54.23)	66 (53.66)	75 (54.74)
Drinking history				0.264
No	180 (69.23)	81 (65.85)	99 (72.26)
Yes	80 (30.77)	42 (34.15)	38 (27.74)
Smoking history				0.932
No	179 (68.85)	85 (69.11)	94 (68.61)
Yes	81 (31.15)	38 (30.89)	43 (31.39)
Body mass index, kg/m²				0.286
< 25	200 (76.92)	91 (73.98)	109 (79.56)
≥ 25	60 (23.08)	32 (26.02)	28 (20.44)
ECOG				0.669
0	172 (66.15)	83 (67.48)	89 (64.96)
1	88 (33.85)	40 (32.52)	48 (35.04)
Site
Stomach	128 (49.23)	68 (55.28)	60 (43.80)	0.062
Gastric and esophageal binding	132 (50.77)	55 (44.72)	77 (56.20)
Histological				0.306
Adenocarcinoma	191 (73.46)	94 (76.42)	97 (70.80)
Others	69 (26.54)	29 (23.58)	40 (29.20)
Staging				0.098
3	80 (30.77)	44 (35.77)	36 (26.28)
4	180 (69.23)	79 (64.23)	101 (73.72)
CEA, ng/mL				0.683
< 3	107 (41.15)	49 (39.84)	58 (42.34)
≥ 3	153 (58.85)	74 (60.16)	79 (57.66)
Peritoneal metastasis				0.172
No	213 (81.92)	105 (85.37)	108 (78.83)
Yes	47 (18.08)	18 (14.63)	29 (21.17)
Liver metastasis				0.815
No	171 (65.77)	80 (65.04)	91 (66.42)
Yes	89 (34.23)	43 (34.96)	46 (33.58)
EBV status				0.826
No-infect	217 (83.46)	102 (82.93)	115 (83.94)
Infect	43 (16.54)	21 (17.07)	22 (16.06)
PD-L1 expression				0.619
CPS < 5	52 (20.00)	23 (18.70)	29 (21.17)
CPS ≥ 5	208 (80.00)	100 (81.30)	108 (78.83)
MMR status				0.113
pMMR	248 (95.38)	120 (97.50)	128 (93.43)
dMMR	12 (4.62)	3 (2.44)	9 (6.57)

FAR: Fibrinogen-to-albumin ratio; ECOG: Eastern Cooperative Oncology Group; CEA: Carcinoembryonic-antigen; EBV: Epstein-Barr virus; PD-L1: Programmed cell death ligand 1; CPS: Combined positive score; MMR: Mismatch repair; pMMR: Proficient mismatch repair; dMMR: Deficient mismatch repair.

Table 2 Tumor responses of fibrinogen to albumin ratio < 0.08 and fibrinogen to albumin ratio ≥ 0.08, n (%)

Variables	Low FAR (n = 123)	High FAR (n = 137)	χ²	P value
CR
0	121 (98.37)	136 (99.27)
1	2 (1.63)	1 (0.73)
PR
0	101 (82.11)	124 (90.51)
1	22 (17.89)	13 (9.49)
SD
0	86 (69.92)	104 (75.91)
1	37 (30.08)	33 (24.09)
PD
0	61 (49.59)	47 (34.31)
1	62 (50.41)	90 (65.69)
ORR			4.49	0.034
0	99 (80.49)	123 (89.78)
1	24 (19.51)	14 (10.22)
DCR			6.24	0.013
0	62 (50.41)	90 (65.69)
1	61 (49.59)	47 (34.31)

FAR: Fibrinogen-to-albumin ratio; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progression disease; ORR: Objective responds rates; DCR: Disease control rates.

Table 3 Univariate and multivariate analyses of prognostic factors for progression-free survival

Factors	Univariate		Multivariate
Factors	HR (95%CI)	P value	HR (95%CI)	P value
Age (< 60 vs ≥ 60), years	1.12 (0.77-1.63)	0.562
Sex (male vs female)	1.07 (0.74-1.55)	0.725
Site (stomach vs gastric and esophageal binding)	1.22 (0.85-1.53)	0.305
ECOG (0 vs 1)	1.55 (1.05-2.29)	0.027	1.55 (1.05-2.28)	0.028
Histological (others vs adenocarcinoma)	0.74 (0.49-1.14)	0.173
FAR (low vs high)	2.18 (1.49-3.20)	< 0.001	1.96 (1.33-2.88)	< 0.001
Staging (3 vs 4)	1.55 (1.01-2.38)	0.045	1.49 (0.97-2.29)	0.072
CEA (< 3 vs ≥ 3), ng/mL	1.09 (0.75-1.59)	0.655
Liver metastasis (no vs yes)	1.03 (0.70- 1.51)	0.896
Peritoneal metastasis (no vs yes)	1.12 (0.68-1.83)	0.664
EBV status (infect vs no-infect)	0.85 (0.51- 1.40)	0.517
PD-L1 expression (CPS < 5 vs CPS ≥ 5)	0.48 (0.31-0.75)	0.001	0.46 (0.29-0.73)	< 0.001
MMR status (dMMR vs pMMR)	2.11 (0.77-5.74)	0.144
BMI (< 25 vs ≥ 25), kg/m²	0.47 (0.29-0.76)	0.002	0.51 (0.31-0.82)	0.006

HR: Hazard ratio; FAR: Fibrinogen-to-albumin ratio; ECOG: Eastern Cooperative Oncology Group; CEA: Carcinoembryonic-antigen; EBV: Epstein-Barr virus; PD-L1: Programmed cell death ligand 1; CPS: Combined positive score; MMR: Mismatch repair; pMMR: Proficient mismatch repair; dMMR: Deficient mismatch repair.

Table 4 Univariate and multivariate analyses of prognostic factors for overall survival

Factors	Univariate		Multivariate
Factors	HR (95%CI)	P value	HR (95%CI)	P value
Age (< 60 vs ≥ 60), years	1.12 (0.77-1.62)	0.563
Sex (male vs female)	0.97 (0.67-1.40)	0.856
Site (stomach vs gastric and esophageal binding)	1.11 (0.76-1.61)	0.595
ECOG (0 vs 1)	1.81 (1.23-2.65)	0.002	1.78 (1.21-2.61)	0.003
Histological (others vs adenocarcinoma)	0.77 (0.50-1.18)	0.234
FAR (low vs high)	2.56 (1.75-3.76)	< 0.001	2.33 (1.59-3.43)	< 0.001
Staging (3 vs 4)	1.95 (1.25-3.05)	0.004	1.93 (1.23-3.03)	0.005
CEA (< 3 vs ≥ 3), ng/mL	1.08 (0.74-1.57)	0.705
Liver metastasis (no vs yes)	1.20 (0.82- 1.75)	0.354
Peritoneal metastasis (no vs yes)	1.21 (0.73-1.98)	0.459
EBV status (infect vs no-infect)	0.71 (0.42- 1.20)	0.200
PD-L1 expression (CPS < 5 vs CPS ≥ 5)	0.49 (0.31-0.77)	0.002	0.45 (0.29-0.71)	< 0.001
MMR status (dMMR vs pMMR)	1.38 (0.61-3.16)	0.441
BMI (< 25 vs ≥ 25), kg/ m²	0.59 (0.36-0.89)	0.013	0.61 (0.39-0.96)	0.033

Table 5 Comparison of features between the training and validation sets, n (%)

Characteristic	Test (n = 78)	Train (n = 182)	χ²	P value
Age, years			0.80	0.370
< 60	39 (50.00)	80 (43.96)
≥ 60	39 (50.00)	102 (56.04)
Sex			0.21	0.645
Female	37 (47.44)	92 (50.55)
Male	41 (52.56)	90 (49.45)
BMI, kg/m²			0.21	0.054
< 25	66 (84.62)	134 (73.63)
≥ 25	12 (15.38)	48 (26.37)
FAR			0.62	0.432
Low	34 (43.59)	89 (48.90)
High	44 (56.41)	93 (51.10)
ECOG			0.21	0.647
0	50 (64.10)	122 (67.03)
1	28 (35.90)	60 (32.97)
Site			0.87	0.350
Stomach	42 (53.85)	86 (47.25)
Gastric and esophageal binding	36 (46.15)	96 (52.75)
Histological			1.74	0.188
Adenocarcinoma	25 (32.05)	44 (24.18)
Other	53 (67.95)	138 (75.82)
Staging			0.77	0.379
3	27 (36.62)	53 (29.12)
4	51 (65.38)	129 (70.88)
CEA, ng/mL			3.60	0.058
< 3	39 (50.00)	68 (37.36)
≥ 3	39 (50.00)	114 (62.64)
Liver metastasis			0.59	0.441
No	54 (69.23)	114 (64.29)
Yes	24 (30.77)	68 (37.36)
Peritoneal metastasis			1.04	0.308
No	61 (78.21)	152 (83.52)
Yes	17 (21.97)	30 (16.48)
EBV status			0.00	0.971
No-infect	65 (83.33)	152 (83.52)
Infect	13 (16.67)	30 (16.48)
PD-L1 expression			0.29	0.588
CPS < 5	14 (17.95)	38 (4.40)
CPS ≥ 5	64 (82.05)	174 (95.60)
MMR status			0.00	1.000
pMMR	4 (5.13)	8 (4.40)
dMMR	74 (94.87)	174 (95.60)

Table 6 Adverse events associated with sintilimab plus chemotherapy in gastric cancer patients, n (%)

Variables	Low FAR (n = 123)	High FAR (n = 137)	χ²	P value
All grades: Anemia	72 (58.54)	84 (61.31)	0.21	0.648
All grades: Leukopenia	68 (55.28)	80 (58.39)	0.26	0.613
All grades: Neutropenia	48 (39.02)	55 (40.15)	0.03	0.854
All grades: Thrombocytopenia	35 (28.46)	43 (31.39)	0.27	0.607
All grades: Fatigue	35 (28.46)	45 (32.85)	0.59	0.444
All grades: Nausea	33 (26.83)	42 (30.66)	0.46	0.496
All grades: Hand-foot syndrome	32 (26.02)	38 (27.74)	0.10	0.755
All grades: Elevated ALT	30 (24.39)	34 (24.82)	0.01	0.936
All grades: Elevated AST	30 (24.39)	32 (23.36)	0.04	0.845
All grades: Pyrexia	28 (22.76)	32 (23.36)	0.01	0.910
All grades: Diarrhea	27 (21.95)	33 (24.09)	0.17	0.683
All grades: Hypertension	20 (16.26)	27 (19.71)	0.52	0.471
All grades: Pneumonitis	18 (14.63)	22 (16.06)	0.10	0.751
All grades: Proteinuria	12 (9.76)	18 (13.14)	0.73	0.394
All grades: Mucositis	10 (8.13)	15 (10.95)	0.59	0.441
≥ 3 grades: Anemia	18 (14.63)	22 (16.06)	0.10	0.751
≥ 3 grades: Leukopenia	15 (12.20)	20 (14.60)	0.32	0.571
≥ 3 grades: Neutropenia	15 (12.20)	18 (13.14)	0.02	0.880
≥ 3 grades: Thrombocytopenia	12 (9.76)	16 (11.68)	0.05	0.576
≥ 3 grades: Fatigue	12 (9.76)	20 (14.60)	0.05	0.820
≥ 3 grades: Diarrhea	8 (6.50)	12 (8.76)	0.46	0.496
≥ 3 grades: Nausea	8 (6.50)	10 (7.30)	0.06	0.801
≥ 3 grades: Elevated ALT	5 (4.07)	7 (5.11)	0.16	0.689
≥ 3 grades: Elevated AST	4 (3.25)	7 (5.11)	0.55	0.458
≥ 3 grades: Hand-foot syndrome	4 (3.25)	5 (3.65)	0.03	0.861
≥ 3 grades: Hypertension	3 (2.45)	4 (2.92)	0.06	0.811
≥ 3 grades: Pneumonitis	3 (2.45)	3 (2.19)	0.02	0.894
≥ 3 grades: Mucositis	0 (0.00)	0 (0.00)	-	-
≥ 3 grades: Pyrexia	0 (0.00)	0 (0.00)	-	-
≥ 3 grades: Proteinuria	0 (0.00)	0 (0.00)	-	-

FAR: Fibrinogen-to-albumin ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Citation: Yao ZY, Liu J, Ma X, Li WT, Shen Y, Cui YZ, Fang Y, Han ZX, Yang CH. Impact of fibrinogen-to-albumin ratio on the long-term prognosis of patients with advanced HER2-negative gastric cancer receiving immunochemotherapy. World J Gastrointest Oncol 2025; 17(6): 107980
URL: https://www.wjgnet.com/1948-5204/full/v17/i6/107980.htm
DOI: https://dx.doi.org/10.4251/wjgo.v17.i6.107980