Cancer Management and Research (May 2022)
The Fibrinogen/Albumin Ratio Index as an Independent Prognostic Biomarker for Patients with Combined Hepatocellular Cholangiocarcinoma After Surgery
Abstract
Jiake Xu,1 Shaochun Li,2 Ye Feng,1 Jie Zhang,1 Youduo Peng,2 Xiaohong Wang,2 Hongwei Wang2 1Department of Gastroenterology, Kunshan Second People’s Hospital, Kunshan, People’s Republic of China; 2Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Hongwei Wang, Tel +86 15021133649, Email [email protected]: The fibrinogen/albumin ratio (FAR) is increasingly considered as a potential biomarker for predicting prognosis in various malignant tumors, whereas the value of the FAR in predicting the recurrence-free survival (RFS) in patients with combined hepatocellular cholangiocarcinoma (cHCC-CCA) after surgery has not been studied.Patients and Methods: A total of 104 patients with surgical-pathologically proved cHCC-CCA were retrospectively analyzed. The best cut-off value of the FAR was calculated via receiver operating characteristic (ROC) curve analysis, and the cohort was then divided into two groups as high-FAR (H-FAR) group and low-FAR (L-FAR) group. The correlation between the preoperative FAR and clinicopathological characteristics was analyzed. Uni- and multi-variable analyses for RFS were evaluated using a Cox proportional hazards model to verify the predictive value of FAR on the RFS of cHCC-CCA. Additionally, a novel clinical nomogram based on FAR was developed to preoperatively predict the RFS of HCC-CCA. The C-index and calibration were conducted to evaluate the performance of the developed nomogram.Results: According to the cut-off value of the FAR, the patients were grouped into the H-FARI (> 0.075) and L-FARI (≤ 0.075) groups. FAR was significantly correlated with several clinical-pathological features, including age, cirrhosis, AFP, CA19-9, BCLC staging, NLR, and PLR. In the multi-variate analysis, FAR, cirrhosis and tumor size were independent prognostic predictors for poor RFS in cHCC-CCA patients after surgery. Moreover, the clinical nomogram based on FAR was constructed, showing well-predictive accuracy.Conclusion: The preoperative FAR is a convenient and feasible serum biomarker for predicting the RFS of cHCC-CCA after surgery. Such developed FAR-based nomogram integrating tumor size and cirrhosis could be served as a feasible and convenient tool to assist the decision-making of clinical strategy.Keywords: combined hepatocellular cholangiocarcinoma, fibrinogen-to-albumin ratio, surgery, prognosis
