NARFIB: A Novel Prognostic Score Based on the Neutrophil-to-Albumin Ratio and Fibrinogen Can Predict the Prognosis of Gastrointestinal Stromal Tumors

Abstract

Rui Li,1,* Zhen Sun,1,* Shibo Song,2 Xiuwen He,1 Xiaolei Shi,1 Zhe Li,1 Jinghai Song1 1Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People’s Republic of China; 2Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinghai SongDepartment of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, No. 1, Dahua Road, Beijing 100730, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: The neutrophil-to-albumin ratio (NAR) and fibrinogen are significantly related to tumor progression. The present study evaluated the prognostic impact of the NAR plus fibrinogen concentration in gastrointestinal stromal tumor (GIST) cases.Methods: The baseline characteristics, postoperative NAR, and fibrinogen concentrations were retrospectively analyzed for 229 Chinese patients who underwent radical gastrectomy for GIST. Receiver operating characteristic (ROC) curves were applied to estimate the optimal critical points for NAR and fibrinogen. Cox regression analysis was applied to determine significant prognostic variables.Results: Multivariate analyses revealed that poor recurrence-free survival was associated with elevated values for fibrinogen (hazard ratio [HR]: 5.015, 95% confidence interval [CI]: 1.993– 12.619, P=0.001) and NAR (HR: 4.669, 95% CI: 1.776– 12.273, P = 0.002). Combining fibrinogen and the NAR into the NARFIB score provided an area under the ROC curve of 0.833, which was greater than the areas for NAR (0.708) or fibrinogen (0.778). When the NAR and fibrinogen were replaced by the NARFIB score in the multivariate analysis, the independent prognosticators were tumor site (HR: 2.927, 95% CI: 1.417– 6.045, P=0.004), mitotic index (HR: 2.661, 95% CI: 1.110– 6.380, P=0.028), and the NARFIB score (HR: 14.116, 95% CI: 3.243– 61.443, P< 0.001). The NARFIB score retained its prognostic significance in various subgroup analyses and was significantly related to gender, surgical approach, tumor size, mitosis, tumor site, risk classification, and recurrence.Conclusion: These results suggest that the NARFIB score may help guide prognostication and risk stratification for GIST, which might benefit from targeted therapy.Keywords: neutrophil-to-albumin ratio, fibrinogen, prognosis, gastrointestinal stromal tumors

Keywords

• neutrophil-to-albumin ratio
• fibrinogen
• prognosis
• gastrointestinal stromal tumors