OncoTargets and Therapy (Dec 2020)

Pretreatment Albumin-to-Fibrinogen Ratio Independently Predicts Chemotherapy Response and Prognosis in Patients with Locally Advanced Rectal Cancer Undergoing Total Mesorectal Excision After Neoadjuvant Chemoradiotherapy

  • Li H,
  • Wang H,
  • Shao S,
  • Gu Y,
  • Yao J,
  • Huang J

Journal volume & issue
Vol. Volume 13
pp. 13121 – 13130


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Hongzhi Li,1 Honggang Wang,2 Shanshan Shao,1 Yawen Gu,1 Juan Yao,1 Junxing Huang1 1Department of Oncology, Taizhou People’s Hospital, Taizhou, Jiangsu, People’s Republic of China; 2Department of General Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu, People’s Republic of ChinaCorrespondence: Junxing HuangDepartment of Oncology, Taizhou People’s Hospital, No. 210 Yingchun Road, Taizhou City, 225300 Jiangsu Province, People’s Republic of ChinaEmail [email protected]: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery of total mesorectal excision (TME) is currently accepted as the standard treatment for locally advanced rectal cancer (LARC). This study aimed to investigate the potential prognostic factors, including the albumin-to-fibrinogen ratio (AFR) for LARC patients.Methods: We retrospectively recruited LARC patients (cT3-4 and/or cN1-2) who underwent nCRT followed by TME between January 2011 and January 2015. The cut-off value of pretreatment AFR for overall survival (OS) was determined by the receiver operating characteristic (ROC) curve. The potential predictive factors for prognosis in the LARC patients were assessed by the univariate and multivariate Cox’s proportional hazard regression and Kaplan–Meier curve analyses.Results: AFR was a significant predictor for OS with a cut-off value of 8.65 and an AUC of 0.882 (P< 0.001). The pretreatment AFR level was the only independent risk factor for pathologic response to nCRT (HR: 2.44, 95% CI: 1.43– 4.17, P=0.003), 5-year OS (HR: 3.31, 95% CI: 1.51– 6.77, P=0.005) and disease-free survival (DFS) (HR: 2.73, 95% CI: 1.34– 5.47, P=0.007) in LARC patients. A low pretreatment AFR level was significantly associated with a poor 5-year OS and DFS by the Log rank test (P=0.003 and 0.006, respectively).Conclusion: Pretreatment AFR level was an independent prognostic factor in LARC patients undergoing TME after nCRT.Keywords: locally advanced rectal cancer, total mesorectal excision, neoadjuvant chemoradiotherapy, prognosis, albumin-to-fibrinogen ratio