1
|
Lu S, Liu Z, Wang Y, Meng Y, Peng R, Qu R, Zhang Z, Fu W, Wang H. A novel prediction model for pathological complete response based on clinical and blood parameters in locally advanced rectal cancer. Front Oncol 2022; 12:932853. [PMID: 36505836 PMCID: PMC9727231 DOI: 10.3389/fonc.2022.932853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to investigate whether clinical and blood parameters can be used for predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Methods We retrospectively enrolled 226 patients with LARC [allocated in a 7:3 ratio to a training (n = 158) or validation (n = 68) cohort] who received nCRT before radical surgery. Backward stepwise logistic regression was performed to identify clinical and blood parameters associated with achieving pCR. Models based on clinical parameters (CP), blood parameters (BP), and clinical-blood parameters (CBP) were constructed for comparison with previously reported Tan's model. The performance of the four models was evaluated by receiver operating characteristic (ROC) curve analysis, calibration, and decision curve analysis (DCA) in both cohorts. A dynamic nomogram was constructed for the presentation of the best model. Results The CP and BP models based on multivariate logistic regression analysis showed that interval, Grade, CEA and fibrinogen-albumin ratio index (FARI), sodium-to-globulin ratio (SGR) were the independent clinical and blood predictors for achieving pCR, respectively. The area under the ROC curve of the CBP model achieved a score of 0.818 and 0.752 in both cohorts, better than CP (0.762 and 0.589), BP (0.695 and 0.718), Tan (0.738 and 0.552). CBP also showed better calibration and DCA than other models in both cohorts. Moreover, CBP revealed significant improvement compared with other models in training cohort (P < 0.05), and CBP showed significant improvement compared with CP and Tan's model in validation cohort (P < 0.05). Conclusion We demonstrated that CBP predicting model have potential in predicting pCR to nCRT in patient with LARC.
Collapse
Affiliation(s)
- Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zhenzhen Liu
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yuxia Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yan Meng
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruize Qu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zhipeng Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing, China,*Correspondence: Hao Wang, ; Wei Fu, ; Zhipeng Zhang,
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, China,Cancer Center, Peking University Third Hospital, Beijing, China,*Correspondence: Hao Wang, ; Wei Fu, ; Zhipeng Zhang,
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China,Cancer Center, Peking University Third Hospital, Beijing, China,*Correspondence: Hao Wang, ; Wei Fu, ; Zhipeng Zhang,
| |
Collapse
|
2
|
Ying HQ, Chen W, Xiong CF, Wang Y, Li XJ, Cheng XX. Quantification of fibrinogen-to-pre-albumin ratio provides an integrating parameter for differential diagnosis and risk stratification of early-stage colorectal cancer. Cancer Cell Int 2022; 22:137. [PMID: 35346200 PMCID: PMC8961931 DOI: 10.1186/s12935-022-02532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/24/2022] [Indexed: 01/05/2023] Open
Abstract
Background Circulating fibrinogen to pre-albumin ratio (FPR) and albumin to fibrinogen ratio (AFR) are effective factors for predicting the prognosis of colorectal cancer (CRC). However, the role of these two ratios in diagnosing early-stage CRC and identifying the stage II CRC subgroup with high relapse risk remains unknown. This study aimed to assess the potential of FPR and AFR in differential diagnosis and risk stratification of early-stage CRC. Methods A discovery (694 and 512 patients with benign colorectal polyps and stage I–II CRC, respectively) and validation (201 benign colorectal polyps cases and 202 stage I–II CRC individuals) cohorts were enrolled in this study. Receiver operating characteristic curve (ROC), Kaplan–Meier curve, and time-dependent ROC were used to evaluate the diagnostic efficacy of AFR and FPR in the two cohorts and overall population, and the discriminating role of FPR in identifying clinical high-relapse risk patients in comparison with common clinical characteristics in stage II CRC patients. Results The area under the curve (AUC) of the preoperative circulating FPR was higher than that of AFR in the diagnosis of stage I–II CRC from colorectal adenomas and benign colorectal polyps in the discovery and validation cohorts and overall population. Carcinoembryonic antigen (CEA) combined with FPR could effectively discriminate early-stage CRC from colorectal adenomas or benign polyps. Preoperative FPR could effectively distinguish stage II subgroups with high and low relapse risk. It was superior to common clinical characteristics in identifying high-risk surgical patients who could benefit from adjuvant chemotherapy (CT) [time-dependent AUC: 0.637 vs. 0.511, p < 0.001 for predicting recurrence-free survival (RFS); 0.719 vs. 0.501, p < 0.001 for predicting overall survival (OS)]. Furthermore, CT treated stage II patients with FPR > 20 had the highest recurrence (31.16%) and death rates (21.88%), with similar highest recurrence (30.70%) and death (26.82%) rates found in non-CT-treated patients with FPR > 20. Stage II CRC patients with 20 ≥ FPR > 15 could significantly benefit from postoperative CT, as the recurrence (33.30%) and death (35.71%) rates within non-CT treated patients were approximately five times higher than those of the CT-treated cases (6.77% and 7.41% for the recurrence and death rates, respectively). No significant difference in recurrence rate was observed between L-FPR (≤ 15) patients with (10.00%) or without CT (9.76%), indicating that these patients might not require to receive adjuvant CT after curative resection. Conclusions Preoperative FPR combined with CEA is superior to common tumor biomarkers, FPR, or AFR in distinguishing early-stage CRC from benign colorectal polyps. Circulating FPR can be an effective biomarker for identifying high-risk patients and choosing suitable therapeutics for early-stage CRC.
Collapse
|
3
|
Li B, Deng H, Zhou Z, Tang B. The Prognostic value of the Fibrinogen to pre-albumin ratio in malignant tumors of the digestive system: a systematic review and meta-analysis. Cancer Cell Int 2022; 22:22. [PMID: 35033080 PMCID: PMC8760749 DOI: 10.1186/s12935-022-02445-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background In recent years, the Fibrinogen to pre-albumin ratio (FPR) has been reported in many studies to be significantly associated with the prognosis of various cancers. This systematic review and meta-analysis aimed to investigate the prognostic value of FPR in malignant tumors of the digestive system based on available evidence. Methods The relevant articles published before July 1, 2021, were systematically retrieved from electronic databases to evaluate the effect of Fibrinogen to pre-albumin ratio (FPR) on the prognosis of patients with malignant digestive system tumors and calculate the hazard ratio (HR) and the corresponding 95% confidence interval (CI). Result Thirteen articles, all from China, including 15 cohort studies and a total of 5116 cases, were included in this study. A high FPR was associated with poor overall survival (HR = 1.88, 95%CI 1.53–2.32, P < 0.001), recurrence-free survival (HR = 2.29, 95%CI 1.91–2.76, P < 0.001), progression-free survival (HR = 1.96, 95%CI: 1.33–2.90, P = 0.001), complications (HR = 1.78, 95%CI: 1.06–3.00, P = 0.029), disease-free survival (HR = 1.46, 95%CI: 1.08–1.97, P = 0.013) was significantly associated with cancer-specific survival (HR = 1.44, 95%CI: 1.15–1.79, P = 0.001). Even though intergroup differences were present, FPR was strongly associated with overall and relapse-free survival, and sensitivity analysis suggested that our results were stable. Conclusion FPR can be used as a valuable indicator to predict the prognosis of patients with malignant digestive system tumors.
Collapse
Affiliation(s)
- Baibei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Huachu Deng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Ziyan Zhou
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Bo Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| |
Collapse
|
4
|
Ying HQ, Sun F, Liao YC, Cai D, Yang Y, Cheng XX. The value of circulating fibrinogen-to-pre-albumin ratio in predicting survival and benefit from chemotherapy in colorectal cancer. Ther Adv Med Oncol 2021; 13:17588359211022886. [PMID: 34262615 PMCID: PMC8243139 DOI: 10.1177/17588359211022886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/17/2021] [Indexed: 01/12/2023] Open
Abstract
Background: To evaluate the prognostic role of circulating fibrinogen-to-pre-albumin
(FPR) in colorectal cancer (CRC) with different tumor locations, and its
involvement in chemosensitivity and chemoresistance. Patients and methods: A total of 2917 eligible CRC patients from multiple centers were enrolled in
this prospective study, and 3 years follow-up was carried out to obtain the
outcome of these patients. Circulating fibrinogen (Fib), pre-albumin (pAlb),
carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were
detected, and we calculated FPR according to the detected results.
Kaplan–Meier curves, Cox proportional regression, time-dependent receiver
operating characteristic curves, Harrell’s concordance index, calibration,
and decision curves were used to investigate the role of FPR in predicting
chemotherapy efficacy and prognosis of CRC patients. Results: Our results showed that cancer bulk, its infiltrating depth, and the distal
metastasis status of CRC determined circulating FPR levels. A high FPR was
associated with a significantly inferior prognosis, while the outcomes of
right-sided patients with stage III and IV CRC were worse than left-sided
cases. Only FPR was found to be a reliable and independent prognostic factor
for each stage of CRC. In addition, the prognostic FPR-contained nomograms
were superior to the non-FPR nomograms and FPR in predicting the outcomes in
both localized and metastatic CRC patients. The circulating FPR was
significantly associated with chemotherapeutic efficacy in stage III and IV
CRC patients. In particular, low-grade (FPR < 15) and medium-grade
(15 ⩽ FPR < 20) FPR patients exhibited a complete response to
chemotherapy and attenuated chemosensitivity, respectively; in contrast,
high-grade inflammation (FPR ⩾ 20) conferred resistance to the
treatment. Conclusion: Circulating FPR is a robust and independent prognostic factor, a simple and
economically-friendly predictor of chemotherapy efficacy within cases of
localized and metastatic CRC. FPR-contained nomograms are more effective in
predicting the prognosis of these patients. FPR and the nomogram can be
recommended for the evaluation of chemotherapy efficacy and to aid
decision-making associated with the management of these patients.
Collapse
Affiliation(s)
| | | | | | - Dan Cai
- Jiangxi Provincial Key Laboratory of Preventive
Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi,
China
| | - Ying Yang
- Jiangxi Provincial Key Laboratory of Preventive
Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi,
China
| | | |
Collapse
|
5
|
Ying HQ, Liao YC, Luo YR, Xiong G, Huang Y, Nie RW, Xiong CF, Cheng XX. Cancer-elicited inflammation attenuates response and outcome in tyrosine kinase inhibitor naive patients with advanced NSCLC. Pharmacol Res 2021; 170:105734. [PMID: 34157424 DOI: 10.1016/j.phrs.2021.105734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/06/2021] [Accepted: 06/15/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cancer elicited inflammation is the main environmental cause leading to carcinogenesis and metastasis of non-small cell lung cancer (NSCLC). Roles of the inflammatory biomarker in predicting the clinical efficacy of tyrosine kinase inhibitor (TKI) and prognosis of naive patients with advanced NSCLC need to be determined, and the best inflammatory predicted biomarker remains unknown. METHODS A total of 178 eligible advanced NSCLC patients (124 and 54 cases within discovery and validation cohorts, respectively) who received first-line EGFR-TKI between July of 2014 and October of 2020 were enrolled in the present study. We detected circulating immune cell counting, albumin (Alb), pre-albumin (pAlb), ALP, AST, LDH, GGT, HDL-c, and fibrinogen (Fib) concentrations, and calculated 22 inflammatory ratios and scores. Logistic regression and Cox proportional hazards models were used to assess the impact of these ratios and scores on objective response and disease control rate (ORR and DCR) as well as progression-free survival (PFS) in these patients. RESULTS Twenty-five percentage and 24.07% of NSCLC patients were observed objective response to the treatment of first-line EGFR-TKI in discovery and validation cohort, respectively. Univariate and multivariate Cox regression showed that high PLR, NPS, SII, SIS, mSIS, GLR and FPR as well as low PNI were significantly associated with poor PFS in discovery cohort. However, only high SII and FPR were found to be associated with unsatisfactory outcome in validation cohort. Time-dependent areas under ROC of FPR were 0.702 (0.517-0.888) in discovery cohort, and 0.767 (0.613-0.921) in validation cohort, which were extremely higher than the other biomarkers. The patients with FPR-SII combined score 2 harbored worse prognosis compared to the combined score 0 in discovery (plog-rank = 0.003, adjusted HR = 2.888, 95%CI = 1.500-5.560) and validation cohort (plog-rank = 0.001, adjusted HR = 3.769, 95%CI = 1.676-8.478) as well as overall population (plog-rank < 0.001, adjusted HR = 3.109, 95%CI = 1.878-5.147), and its time-dependent AUCs were 0.747 (0.594-0.900) and 0.815 (0.688-0.942) in the two cohorts, respectively, which were significantly higher than the single biomarker in the two cohorts. The patients with high FPR and FPR-SII score harbored worse DCR than the low patients in the two cohorts and overall population, respectively. Moreover, the similar poor survival was observed in advanced high-FPR NSCLC patients with different treatment options, however, the survival of low-FPR patients with treatment of single TKI, radiotherapy or chemotherapy or radio-chemotherapy combined TKI was good compared to the high-FPR patients with radio-chemotherapy combined TKI, and the survival differences were observed between TKI (plog-rank < 0.001) or radiotherapy combined TKI (plog-rank = 0.014) treated low-FPR patients and the high FPR patients. Additionally, FPR-SII combined score could monitor the progression of the disease in real-time, and the median month of the positive score appearance was significantly earlier than CT/MRI detection (p < 0.001 for 3 months vs. 13 months). CONCLUSIONS High-grade cancer elicited inflammation could attenuates response and outcome in tyrosine kinase inhibitor naive patients with advanced NSCLC. FPR-SII combined score was the best inflammatory biomarker to monitor and predict the progression of advanced NSCLC patients with treatment of TKI.
Collapse
Affiliation(s)
- Hou-Qun Ying
- Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Yu-Cui Liao
- Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China
| | - Yan-Ran Luo
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Gang Xiong
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Ying Huang
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Ruo-Wei Nie
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Cui-Fen Xiong
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Xue-Xin Cheng
- Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| |
Collapse
|
6
|
Ying HQ, You XH, Liao YC, Sun F, Cheng XX. High-Grade Inflammation Attenuates Chemosensitivity and Confers to Poor Survival of Surgical Stage III CRC Patients. Front Oncol 2021; 11:580455. [PMID: 33968712 PMCID: PMC8103203 DOI: 10.3389/fonc.2021.580455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Heterogeneous clinical and molecular characteristics are reported in colorectal cancer (CRC) with different tumor laterality. However, the outcome of left- and right-sided patients with stage I–III CRC and the role of chronic inflammation in survival differences between them remain unclear. Method: A prospective study including 1,181 surgical patients with stage I–III CRC was carried out to investigate the involvement of circulating fibrinogen-to-pre-albumin (Alb) ratio (FPR) and primary tumor sidedness in the clinical outcome of those patients. We further investigated the effect of FPR on adjuvant chemotherapy response and recurrence in stage III patients. Results: Our study showed that the right tumor location was significantly associated with poor recurrence-free survival (RFS) (p = 0.04, adjusted HR = 1.41, 95% CI = 1.02–1.94) and overall survival (OS) (p = 0.04, adjusted HR = 1.55, 95% CI = 1.01–2.38) only in the stage III disease. In these patients, T4 stage distribution (83.39 vs. 70.94%, p < 0.01) within right-sided cases was significantly higher than left-sided patients. Moreover, preoperative FPR within right-sidedness (p < 0.01), T4 stage (p < 0.05), and large cancer bulk (≥5 cm) (p < 0.05) subgroups was significantly elevated compared to their counterparts, and it was gradually rising following the increased cancer bulk (p trend < 0.01). High-FPR distribution (52.30 vs. 27.00%, p < 0.01) within right-sided patients with the stage III disease was significantly higher than that in the left-sided cases. RFS (plog−rank < 0.01) and OS (plog−rank < 0.01) of the high-FPR patients were extremely inferior to the low-FPR cases, and the significant associations were observed when they were adjusted by other confounders including primary tumor location (p < 0.01, adjusted HR = 1.96, 95% CI = 1.42–2.70 for RFS; p < 0.01, adjusted HR = 2.44, 95% CI = 1.59–3.75 for OS). Additionally, RFS of adjuvant chemotherapy-treated high-FPR patients was superior to the patients without chemotherapy (plog−rank = 0.01) but was inferior to the low-FPR patients undergoing the treatment, especially in the 5-FU- and XELOX-treated subgroup. Conclusion: These findings indicate that chronic high-grade inflammation weakens chemotherapy efficacy and contributes to the poor prognosis of stage III surgical CRC patients.
Collapse
Affiliation(s)
- Hou-Qun Ying
- Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xia-Hong You
- Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Cui Liao
- School of Public Health, Nanchang University, Nanchang, China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue-Xin Cheng
- Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
7
|
Liao YC, Ying HQ, Huang Y, Luo YR, Xiong CF, Nie RW, Li XJ, Cheng XX. Role of Chronic Inflammatory Ratios in Predicting Recurrence of Resected Patients with Stage I-III Mucinous Colorectal Adenocarcinoma. Cancer Manag Res 2021; 13:3455-3464. [PMID: 33907468 PMCID: PMC8068493 DOI: 10.2147/cmar.s303758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Cancer-related inflammation is the main cause of the progression of mucinous colorectal adenocarcinoma (MCA). Circulating fibrinogen-to-pre-albumin ratio (FPR) is associated with the clinical outcome in colorectal cancer (CRC). However, the prognostic role of FPR and which is the best inflammatory prognostic biomarker within MCA remain unknown. Methods We enrolled 157 patients with stage I–III MCA in this study. Kaplan-Meier curve, Cox regression, and time-dependent receiver operation characteristic curve analysis were performed to assess the prognostic value and efficacy of the neutrophil-to-albumin ratio (NAR), neutrophil-to-pre-albumin ratio (NPAR), albumin-to-alkaline phosphatase ratio (AAPR), albumin-to-globulin ratio (AGR), albumin-to-fibrinogen ratio (AFR), and FPR in these patients. Results We found that NAR, NPAR, and FPR were significantly associated with unsatisfactory recurrence-free survival (RFS) in patients with stage I–III MCA, and the predicted efficacy of FPR was superior to that of the other two inflammatory biomarkers. Moreover, patients with a high combined TNM-CA199-FPR score had worse outcomes, with a high predicted efficacy of up to 0.779 (0.703–0.856). Using FPR, the patient was monitored for the recurrence up to two months earlier than that achieved using the common imaging techniques (4 vs 6 median months) in stage I–III MCA patients undergoing radical resection. Conclusion FPR is the preferred inflammatory biomarker and commonly used for predicting and monitoring recurrence in stage I–III MCA patients. The combined TNM-CA199-FPR score is an economical, simple, effective, and independent prognostic factor for localized disease.
Collapse
Affiliation(s)
- Yu-Cui Liao
- School of Public Health; Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Hou-Qun Ying
- Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Ying Huang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Yan-Ran Luo
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Cui-Fen Xiong
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Ruo-Wei Nie
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Xiao-Juan Li
- Department of Clinical Laboratory, Kunming Children's Hospital, Kunming, Yunnan, 650500, People's Republic of China
| | - Xue-Xin Cheng
- School of Public Health; Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| |
Collapse
|
8
|
Lu S, Liu Z, Wang B, Li F, Meng Y, Wang J, Wang Y, Wang H, Zhou X, Fu W. High CFP score indicates poor prognosis and chemoradiotherapy response in LARC patients. Cancer Cell Int 2021; 21:205. [PMID: 33849545 PMCID: PMC8045186 DOI: 10.1186/s12935-021-01903-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Preoperative tumor markers, inflammation, and nutritional status are considered important predictors of prognosis and tumor response in locally advanced rectal cancer (LARC) patients. This study aims to explore the prognostic and predictive role of carcinoembryonic antigen (CEA), the Fibrinogen-Albumin Ratio Index (FARI), the Prognostic Nutritional Index (PNI) in LARC patients and compared them with a novel combined CEA-FARI-PNI (CFP) scoring system. METHODS A total of 138 LARC patients undergoing radical surgery following neoadjuvant chemoradiotherapy (NCRT) between January 2012 and March 2019 were enrolled. The X-tile program was used to determine the optimal cut-off values of CEA, FARI, and PNI, and CFP scoring system was constructed accordingly. The prognostic ability of these factors was assessed by the time-dependent receiver operating characteristic (ROC) curve, Kaplan-Meier, Cox regression, and logistic regression. Nomogram was established to evaluate the predictive role of these factors in tumor response. RESULTS The optimal cut-off values of CEA, FARI, and PNI were 5.15 ng/l, 10.56%, and 42.25 g/L, respectively. The time-dependent ROC curve showed that compared to CEA, FARI, and PNI, CFP showed stable predictive efficacy for overall survival (OS) and disease-free survival (DFS). In multivariate analysis, CFP was the only factor that could independently predict OS (HR = 8.117, p = 0.001) and DFS (HR = 4.994, p < 0.001). Moreover, high CFP (OR = 3.693, p = 0.002) was also an independent risk factor of poor response. The area under the ROC curve (AUC) of the nomograms for predicting tumor response was better including CFP (0.717) than without CFP (0.656) (p < 0.05). CONCLUSIONS The CFP score was a more reliable marker for predicting OS, DFS, and NCRT efficacy in LARC patients, and the score could apparently improve predicted efficacy of the nomogram.
Collapse
Affiliation(s)
- Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Zhenzhen Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Bingyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Fei Li
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yan Meng
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Junwei Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, 100191, China
| | - Hao Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, 100191, China.
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
| |
Collapse
|
9
|
Liao YC, Fu M, Wang XF, Cheng XX. Combined fibrinogen-to-pre-albumin ratio and carbohydrate antigen 19-9 score is a promising metric to predict progression of metastatic colorectal mucinous adenocarcinoma. J Clin Lab Anal 2021; 35:e23757. [PMID: 33734488 DOI: 10.1002/jcla.23757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic inflammation is a hallmark of colorectal mucinous adenocarcinoma (CMA). Albumin-to-fibrinogen ratio (AFR) and fibrinogen-to-pre-albumin ratio (FPR) were independent prognostic factors for many kinds of solid malignancies. However, the association between the inflammatory scores and progression of metastatic CMA remains unknown. METHODS Peripheral blood neutrophil count and circulating fibrinogen, albumin, and pre-albumin levels were detected, and neutrophil-to-albumin ratio (NAR), neutrophil-to-pre-albumin ratio(NPAR), AFR, and FPR were calculated in 42 metastatic MCA patients. Kaplan-Meier curve, Cox regression, time-dependent receiver operating characteristic curve (tdROC) were selected to investigate the prognostic utility of them in the patients. RESULTS Metastatic CMA patients commonly occurred in middle-younger patients (80.95%). NPAR (adjusted hazard ratio (HR)=2.405, 95% confidence interval (CI)=1.195-4.842) and FPR (plog-rank =0.007, adjusted HR=2.364, 95% CI=1.203-4.645) were significantly associated with poor progression-free survival in these patients. The prognostic prediction area under tdROC (AUROC) of FPR was significantly higher than that of NPAR(0.703 versus 0.537). Moreover, the patients with a high CA19-9-FPR score showed worse outcomes than those with the low score (plog-rank <0.001, adjusted HR=7.273, 95% CI=2.721-19.435 for the score 1 versus 0). The prediction AUROC, sensitivity, and specificity of the score were 0.892 (0.788-0.996), 76.32%, and 100.00%, respectively, and its predicted efficacy was better than that of the single biomarkers. CONCLUSION The combined CA19-9-FPR score is an economical, simple, effective, and independent prognostic factor for metastatic MCA.
Collapse
Affiliation(s)
- Yu-Cui Liao
- School of Public Health, Nanchang University, Nanchang, PR China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, PR China.,Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ming Fu
- School of Public Health, Nanchang University, Nanchang, PR China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, PR China.,Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue-Feng Wang
- Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue-Xin Cheng
- School of Public Health, Nanchang University, Nanchang, PR China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, PR China.,Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
10
|
Chen C, Liu Y, Han P, Cui B. Research Progress of Preoperative FPR, FAR or AFR in Patients with Colorectal Cancer. Cancer Manag Res 2021; 13:1791-1801. [PMID: 33654428 PMCID: PMC7910077 DOI: 10.2147/cmar.s292605] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Research has confirmed that plasma albumin (Alb), prealbumin (PA) and fibrinogen (Fib) are involved in regulating the occurrence and development of various tumors. Their levels in peripheral blood are related to the survival outcome and treatment response of patients, but the accuracy and specificity of single application have yet to be fully realized. A growing amount of evidence indicates that predictors such as preoperative fibrinogen to prealbumin ratio (FPR), fibrinogen to albumin ratio (FAR) or albumin to fibrinogen ratio (AFR) are emerging as comprehensive indicators. Indeed, their components play a key regulatory role in the progression of colorectal cancer (CRC). Preoperative FPR, FAR or AFR levels, therefore, are expected to become new biomarkers for prognosis evaluation and curative effect prediction for CRC patients and are significant in the guidance they could provide for the development of individualized treatment strategies.
Collapse
Affiliation(s)
- Chen Chen
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Peng Han
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| |
Collapse
|
11
|
Ying HQ, Liao YC, Sun F, Peng HX, Cheng XX. The Role of Cancer-Elicited Inflammatory Biomarkers in Predicting Early Recurrence Within Stage II-III Colorectal Cancer Patients After Curable Resection. J Inflamm Res 2021; 14:115-129. [PMID: 33500648 PMCID: PMC7822081 DOI: 10.2147/jir.s285129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background Smoldering cancer-related inflammation attenuates chemotherapy efficacy and contributes to unsatisfactory outcome for patients of colorectal cancer (CRC). Various inflammation-based biomarkers were reported to predict the survival of the disease, however, it remains unclear which is the best inflammation-based biomarker. The aim of present study was to compare the prognostic role of those biomarkers and to establish superior survival score for post-recurrence survival in radically operative patients with stage II–III CRC. Patients and Methods Preoperative peripheral neutrophil, lymphocyte, monocyte, platelet, serum albumin (Alb), pre-Alb, and plasma fibrinogen (Fib) were detected in the discovery and validation cohort which included a total of 1533 stage II–III surgical CRC patients. We calculated and compared fourteen inflammation-based biomarkers for predicting recurrence-free survival (RFS) of the patients with stage II–III CRC. Results In this study, the platelet to lymphocyte ratio (PLR), lymphocyte to monocyte (LMR), systemic inflammation response index (SIRI), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), modified systemic inflammation score (mSIS), fibrinogen and neutrophil to lymphocyte ratio score (F-NLR), ratio of Alb to Fib (AFR), and ratio of Fib to pre-Alb (FPR) were all related to the RFS of the patients in both discovery and validation cohorts, however, only the LMR, SIRI, PNI, mSIS, F-NLR, AFR and FPR remained independent predictors for RFS in multivariate analysis. Both the C-index of the FPR (0.629 for 36 months) and the areas under the time-dependent receiver operating characteristic (ROC) curves (0.625 for 12 months, 0.641 for both 24 and 0.637 months) showed that it was superior to the other inflammation-based prognostic scores for predicting the RFS of stage II–III surgical CRC patients. Moreover, elevated FPR was significantly associated with unsatisfactory RFS regardless of TNM stage and primary tumor location. Stage II low FPR patients showed the best RFS regardless of chemotherapy. The better RFS was observed in chemotherapy-treated stage II high FPR patients than those without the treatment, and the outcomes of patients with treatment of XELOX, capecitabine and XELOX were superior to the other regimens to treat patients in stage III low- and high-FPR populations, respectively. Additionally, the carcinoembryonic antigen (CEA)-FPR combined score one (adjusted HR=2.764, 95% CI=2.129–3.589) and two (adjusted HR=3.543, 95% CI=2.317–5.420) were extremely associated with RFS of these patients, and the predicted AUC of the combined score for 12, 24 and 36 months were 0.657, 0.657 and 0.653 in stage II–III patients, which were superior to the single CEA and FPR, respectively. Conclusion In conclusion, FPR is superior to the other inflammatory biomarkers as a useful recurrence indicator in stage II–III surgical CRC patients in terms of prognostic ability; it helps to choose the effective chemotherapy regimen and to increase the predicted efficacy of CEA and the combined CEA and FPR score could effectively predict recurrence of the patients.
Collapse
Affiliation(s)
- Hou-Qun Ying
- Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People's Republic of China
| | - Yu-Cui Liao
- Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People's Republic of China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, People's Republic of China
| | - Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People's Republic of China
| | - Hong-Xin Peng
- Department of Clinical Laboratory, Nanjing First Hospital, Nanjing, Jiangsu 210000, People's Republic of China
| | - Xue-Xin Cheng
- Biological Resource Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People's Republic of China.,Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, People's Republic of China
| |
Collapse
|
12
|
Prognostic Significance of Preoperative Fibrinogen-to-Prealbumin Ratio in Patients with Stage I-III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3905353. [PMID: 33521127 PMCID: PMC7817313 DOI: 10.1155/2021/3905353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
Background The objective of this study was to explore the role of preoperative fibrinogen-to-prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I–III colorectal cancer (CRC). Methods This retrospective study enrolled 584 stage I–III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan-Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time-dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results FPR was determined to be an independent factor affecting postoperative complications. Patients with a low-FPR had a significantly better prognosis than those with a high-FPR (disease-free survival, p = 0.028; overall survival, p = 0.027), especially patients with stage I CRC (disease-free survival, p = 0.015; overall survival, p = 0.017). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease-free survival (hazard ratio (HR) = 1.459, 95% confidence interval (CI) = 1.074–1.954, p = 0.011) and overall survival (HR = 1.405, 95% CI = 1.034–1.909, p = 0.030). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions FPR is a potential indicator for predicting short- and long-term prognosis of stage I–III CRC patients undergoing surgical resection.
Collapse
|
13
|
You XH, Jiang YH, Fang Z, Sun F, Li Y, Wang W, Xia ZJ, Wang XZ, Ying HQ. Chemotherapy plus bevacizumab as an optimal first-line therapeutic treatment for patients with right-sided metastatic colon cancer: a meta-analysis of first-line clinical trials. ESMO Open 2020; 4:S2059-7029(20)30051-X. [PMID: 32132090 PMCID: PMC7064070 DOI: 10.1136/esmoopen-2019-000605] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background Monoclonal antibodies of anti-epidermal growth factor receptor (EGFR) have been recommended as first-line therapy for patients with left-sided metastatic colorectal cancer (mCRC) with wild-type RAS. The effect of tumour laterality on antivascular endothelial growth factor antibody and how to optimise targeted therapies for the right-sided cases remain controversial. Patients and methods A comprehensive meta-analysis enrolling 16 first-line clinical trials was performed to evaluate the efficacy of chemotherapy alone and chemotherapy plus targeted therapies for patients with mCRC with right primary tumour site, and we validated the results in metastatic setting (14 trials containing 4306 patients with unresectable mCRC). Results Here, we found that progression-free survival (PFS) (combined HR 1.30, 95% CI 1.17 to 1.44) and overall survival (OS) (combined HR 1.46, 95% CI 1.32 to 1.62) of the right-sided patients were significantly inferior to the left-sided individuals receiving chemotherapy alone in overall population, regardless of race. Similar results were also observed in metastatic setting. OS of patients with left-sided mCRC receiving chemotherapy plus bevacizumab was superior to the right-sided individuals (combined median survival ratio (MSR)=1.23, 95% CI 1.08 to 1.39 for overall population; combined MSR=1.23, 95% CI 1.05 to 1.45 for metastatic setting), especially for wild-type RAS and mixed population. Moreover, the right-sided patients benefited more from chemotherapy plus bevacizumab comparing with chemotherapy alone in both overall population and metastatic setting. Importantly, the RAS-wild right-sided patients achieved longer PFS (combined HR 0.67, 95% CI 0.52 to 0.88) and OS (combined HR 0.74, 95% CI 0.56 to 0.98) from chemotherapy plus bevacizumab comparing with chemotherapy associated with anti-EGFR agents. Conclusions Patients with right-sided mCRC show impaired chemosensitivity, and chemotherapy plus bevacizumab can be an optimal first-line therapeutic regimen for the RAS-wild patients with right-sided mCRC.
Collapse
Affiliation(s)
- Xia-Hong You
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yu-Huan Jiang
- Department of Clinical Laboratory, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhou Fang
- Department of Laboratory Medicine, Nanchang University Medical College, Nanchang, Jiangxi, China
| | - Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Li
- Department of Laboratory Medicine, Nanchang University Medical College, Nanchang, Jiangxi, China
| | - Wei Wang
- Department of Laboratory Medicine, Nanchang University Medical College, Nanchang, Jiangxi, China
| | - Zi-Jin Xia
- Department of Laboratory Medicine, Nanchang University Medical College, Nanchang, Jiangxi, China
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hou-Qun Ying
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China .,Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
14
|
Lu S, Liu Z, Zhou X, Wang B, Li F, Ma Y, Wang W, Ma J, Wang Y, Wang H, Fu W. Preoperative Fibrinogen-Albumin Ratio Index (FARI) is a Reliable Prognosis and Chemoradiotherapy Sensitivity Predictor in Locally Advanced Rectal Cancer Patients Undergoing Radical Surgery Following Neoadjuvant Chemoradiotherapy. Cancer Manag Res 2020; 12:8555-8568. [PMID: 32982448 PMCID: PMC7505706 DOI: 10.2147/cmar.s273065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background Inflammatory response and nutritional status are associated with cancer development and progression. The purpose of this study was to explore whether the preoperative fibrinogen-albumin ratio index (FARI) is related to prognosis and chemoradiotherapy outcome of radical surgery after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC). Methods In total, 123 patients with LARC who underwent radical surgery after NCRT between June 2012 and December 2018 were collected in this study. Time-dependent receiver operating characteristic (ROC) curve analysis was made to evaluate the ability of the markers for forecasting prognosis. The correlation between FARI and clinicopathological parameters was analyzed. The Kaplan-Meier survival analysis, univariate and multivariate analysis based on Cox proportional hazards models, and subgroup analysis were performed to evaluate overall survival (OS) and disease-free survival (DFS). A nomogram was constructed to evaluate the predictive role of FARI in DFS. Results The ROC curve analysis showed that the ability of FARI on DFS prediction was superior to those of other inflammatory markers and carcinoembryonic antigen (CEA) (P<0.05). Based on the Youden's index, the optimal cut-off value of FARI was 8.8%. High FARI patients (>8.8%) showed a poor response to NCRT and a decreased DFS rate (P<0.05). In addition, multivariate analysis revealed that FARI (HR=3.098, P=0.033), neutrophil-to-lymphocyte ratio (NLR), and postoperative T stage were independent prognostic factors for DFS in TNM stage III LARC patients. However, FARI failed to distinguish patients with poor OS. Harrell's concordance index (C-index) of the nomogram containing FARI (0.807) was obviously higher than that without it (0.732) among LARC patients who underwent radical surgery after NCRT. Moreover, multivariate analysis revealed FARI (OR=3.044, P=0.012) as an independent predictor for response to NCRT. Conclusion Among LARC patients who underwent radical surgery after NCRT, preoperative FARI is an independent prognostic factor for DFS and an independent predictor for response to NCRT.
Collapse
Affiliation(s)
- Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Zhenzhen Liu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Bingyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Fei Li
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Yanpeng Ma
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Wendong Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Junren Ma
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Yuxia Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Hao Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, People's Republic of China
| |
Collapse
|
15
|
Tang S, Lin L, Cheng J, Zhao J, Xuan Q, Shao J, Zhou Y, Zhang Y. The prognostic value of preoperative fibrinogen-to-prealbumin ratio and a novel FFC score in patients with resectable gastric cancer. BMC Cancer 2020; 20:382. [PMID: 32375697 PMCID: PMC7201974 DOI: 10.1186/s12885-020-06866-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Chronic inflammation is considered as a hallmark of gastric cancer (GC) and plays a critical role in GC progression and metastasis. This study aimed to explore the prognostic values of preoperative fibrinogen-to-prealbumin ratio (FPR), fibrinogen-to-albumin ratio (FAR), and novel FPR-FAR-CEA (FFC) score in patients with GC undergoing gastrectomy. Methods A total of 273 patients with resectable GC were included in this retrospective study. We performed Kaplan-Meier and Cox regression analyses to assess the prognostic role of preoperative FPR, FAR, and FFC score in patients with GC and analyze their relationships with clinicopathological features. Results Receiver operating characteristic curve (ROC) analysis revealed that the optimal cutoff values for FPR and FAR were 0.0145 and 0.0784, respectively. The FFC score had a higher area under the ROC curve than FAR and CEA. Elevated FPR (≥ 0.0145) and FAR (≥ 0.0784) were significantly associated with old age, large tumor size, tumor invasion depth, lymph nodes metastasis, advanced TNM stage, large Borrmann type, and anemia status. Kaplan-Meier analysis showed that high FPR, FAR, and FFC score were related to poor survival. Multivariate analyses indicated that FPR, FFC score, TNM stage, and tumor size were significant independent factors for survival. Conclusions Preoperative FPR and FFC score could be used as prospective noninvasive prognostic biomarkers for resectable GC.
Collapse
Affiliation(s)
- Shuli Tang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Lin Lin
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Jianan Cheng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Juan Zhao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Qijia Xuan
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Jiayue Shao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China.
| | - Yanqiao Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, China.
| |
Collapse
|
16
|
Sun DW, An L, Lv GY. Albumin-fibrinogen ratio and fibrinogen-prealbumin ratio as promising prognostic markers for cancers: an updated meta-analysis. World J Surg Oncol 2020; 18:9. [PMID: 31931816 PMCID: PMC6958612 DOI: 10.1186/s12957-020-1786-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Provide an updated and comprehensive evaluation of the prognostic value of the albumin-fibrinogen ratio (AFR) and the fibrinogen-prealbumin ratio (FPR) for patients with cancer. Materials and methods Four databases (PubMed, Web of Science, Cochrane Library, and WanFang) were searched. The primary endpoints were overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). Pooled data were synthesized using StataMP 14 and expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). Results This update examined 19 studies (7282 cases) that assessed the correlation of AFR with cancer prognosis. Pooled univariate and multivariate analyses indicated significant correlations of low AFR with poor OS (HR 2.18, 95%CI 1.87–2.55 and HR 1.75, 95%CI 1.54–2.00, respectively), poor DFS (HR 1.89, 95%CI 1.54–2.32 and HR 1.51, 95%CI 1.29–1.76, respectively), and poor PFS (HR 1.68, 95%CI 1.42–1.99 and HR 1.48, 95%CI 1.16–1.88, respectively). Pooled univariate and multivariate analyses of 6 studies (2232 cases) indicated high FPR significantly correlated with poor OS (HR 2.37, 95%CI 2.03–2.77 and HR 1.97, 95%CI 1.41–2.77, respectively). One study reported that high FPR correlated with poor DFS (univariate analysis: HR 2.20, 95%CI 1.35–3.57; multivariate analysis: HR 1.77, 95%CI 1.04–2.99) and one study reported a correlation of high FPR with poor PFS in univariate analysis alone (HR 1.79, 95%CI 1.11–2.88). Conclusion A low AFR and a high FPR correlated with increased risk of cancer mortality and recurrence. AFR and FPR may be promising prognostic markers for cancers.
Collapse
Affiliation(s)
- Da-Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun, Jilin, 130021, China
| | - Lin An
- Department of Hand surgery, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, 130033, China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun, Jilin, 130021, China.
| |
Collapse
|
17
|
Li SQ, You XH, Sun F, Xia ZJ, Fang Z, Wang W, Li Y, Wang XZ, Ying HQ. Albumin to fibrinogen ratio and fibrinogen to pre-albumin ratio are economical, simple and promising prognostic factors for solid malignancy. J Thorac Dis 2019; 11:S2036-S2038. [PMID: 31632821 DOI: 10.21037/jtd.2019.08.96] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shu-Qi Li
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xia-Hong You
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Zi-Jin Xia
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Zhou Fang
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Wei Wang
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Yao Li
- Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Hou-Qun Ying
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.,Department of Nuclear Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| |
Collapse
|
18
|
You XH, Wen C, Xia ZJ, Sun F, Li Y, Wang W, Fang Z, Chen QG, Zhang L, Jiang YH, Wang XZ, Ying HQ, Zong Z. Primary Tumor Sidedness Predicts Bevacizumab Benefit in Metastatic Colorectal Cancer Patients. Front Oncol 2019; 9:723. [PMID: 31475100 PMCID: PMC6702298 DOI: 10.3389/fonc.2019.00723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/19/2019] [Indexed: 12/17/2022] Open
Abstract
The emerging debate between primary tumor location and clinical outcome of bevacizumab treated metastatic colorectal cancer (mCRC) continues. The aim of the present study is to investigate the association between the primary tumor location and clinical outcome of 115 mCRC patients receiving bevacizumab based treatment. A meta-analysis including 21 studies was carried out to confirm the conclusion. In our prospective study, we found that right-sided mCRC commonly occurred in older cases (p = 0.03) with multiple-site metastasis (p = 0.03). Progression-free survival (PFS) of the left-sided patients undergoing bevacizumab plus a FOLFIRI regimen was superior to the right-sided cases (p = 0.03, crude HR = 0.31, 95%CI = 0.11-0.87; adjusted HR = 0.21, 95%CI = 0.06-0.66). The meta-analysis confirmed that efficacy of bevacizumab-based treatment in left-sided mCRC patients was better than the right-sided cases in the overall population (P h = 0.24, combined OR = 1.36, 95%CI = 1.07-1.72), RAS/BRAF wild-type (P h = 0.19, combined OR = 1.66, 95%CI = 1.17-2.34), clinical trial (P h = 0.23, combined OR = 1.42, 95%CI = 1.07-1.88), Caucasian population (P h = 0.18, combined OR = 1.37, 95%CI = 1.02-1.85) and first-line (P h = 0.19, combined OR = 1.48, 95%CI = 1.13-1.96) subgroups. Improved survival of bevacizumab plus chemotherapy treated left-sided mCRC patients was observed in the overall population [P h < 0.01, combined MSR = 1.09, 95%CI = 1.00-1.18 for PFS; P h < 0.01, combined MSR = 1.24, 95%CI = 1.13-1.36 for overall survival (OS)], especially in the RAS/BRAF wild-type (P h = 0.09, combined MSR = 1.10, 95%CI = 1.03-1.19 for PFS; P h = 0.02, combined MSR = 1.34, 95%CI = 1.21-1.49 for OS). These findings indicate that primary tumor sidedness can predict clinical outcome of bevacizumab-treated RAS/BRAF wild-type mCRC patients and the left-sided patients may benefit more from bevacizumab plus FOLFIRI.
Collapse
Affiliation(s)
- Xia-Hong You
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Can Wen
- Department of Clinical Laboratory, Jiangxi Cancer Hospital, Nanchang, China
| | - Zi-Jin Xia
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yao Li
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wei Wang
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhou Fang
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qing-Gen Chen
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Zhang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu-Huang Jiang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hou-Qun Ying
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Nuclear Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhen Zong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|