Clinical Significance of Fibrinogen and Platelet to Pre-Albumin Ratio in Predicting the Prognosis of Advanced Gastric Cancer

Abstract

Objective

The aim of this study was to investigate the clinical significance of Fibrinogen and Platelet to Pre-albumin Ratio(FPAR) in predicting the prognosis of patients with advanced gastric cancer(AGC) and to construct a predictive model.

Methods

We collected clinical data from 489 postoperative patients with AGC. FPAR was divided into high and low groups according to the receiver operating characteristic (ROC) curve. The value of FPAR in predicting the prognosis of progressive gastric cancer was analysed using univariate and multivariable Cox regression analysis and its relationship with clinicopathological features. Finally, the Overall Survival(OS) and recurrence-free survival(RFS) prediction models were constructed and validated using FPAR.

Results

Univariate and multifactorial cox regression analysis showed that grade (P<0.001), TNM-stage (P<0.001), chemotherapy (P<0.001), and FPAR (OR=3.054,95% CI:2.088–4.467, P<0.001) were independent risk factors for OS; grade (P=0.021), N-stage (P=0.024), TNM-stage (P=0.033), and FPAR (OR=2.215,95% CI:1.634–3.003, P<0.001) were independent risk factors for RFS. Subgroup analysis showed that the FPAR-low group had higher OS and RFS than the FPAR-high group, regardless of the patient’s TNM stage (p<0.05). However, OS was instead higher in the the stage III-FPAR-low group than in the the stage II-FPAR-high group (p<0.05), while RFS was not significantly different. Predictive models incorporating FPAR had better predictive performance than those without FPAR, showing wide range of net benefit and AUC. After correction, the 2-year AUC, 3-year AUC and C-index of the OS model were 0.737, 0.756, and 0.746; the 2-year AUC, 3-year AUC, and C-index of the RFS model were 0.738, 0.758, and 0.711.

Conclusion

FPAR levels were associated with prognosis in patients with AGC and could independently predict RFS and OS.

Keywords:

• advanced gastric cancer
• FPAR
• overall survival
• recurrence-free survival
• prognosis

Abbreviations

FPAR, Fibrinogen and platelet to pre-albumin ratio, FPAR= (Fibrinogen*Platelet count)/pre-Albumin; SIRI, Systemic inflammation response index, SIRI= Neutrophil count * Monocyte count/Lymphocyte count; NLR, Neutrophil to lymphocyte ratio; PLR, Platelet count and the lymphocyte absolute value ratio; OS, Overall survival; RFS, Recurrence-free survival; AGC, Advanced gastric cancer; DCA, Decision curve analysis; C-index, Concordance index.

Disclosure

The authors declare no competing interests in this work.

Additional information

Funding

This research was financially supported by the National Natural Science Foundation of China (Grant Number: 82060453 and 82103645 and 82260596);Training Plan for Academic and Technical Young Leaders of Major Disciplines in Jiangxi Province(Grant Number: 20204BCJ23021);TCM scientific research project of Jiangxi Provincial Health and Family Planning Commission(Grant Number: 2018B038);Research subject of educational reform of Nanchang University(NCUJGLX-2022-160-96) and Science and Technology Program of Jiangxi Provincial Health and Wellness Commission (202310221).