A cumulative score based on preoperative fibrinogen and the neutrophil–lymphocyte ratio to predict outcomes in resectable gastric cancer

Abstract

BackgroundRecent studies have revealed that preoperative fibrinogen and the neutrophil–lymphocyte ratio (NLR) are associated with poor outcome in gastric cancer (GC). We aimed to evaluate whether the fibrinogen and the NLR score had a consistent prognostic value for resectable GC.MethodsWe analyzed 1,293 consecutive patients who underwent curative surgery for GC. The F-NLR score was 2 for patients with hyperfibrinogenemia (>400 mg/dL) and elevated NLR (≥5.0), 1 for those with one abnormal index, and 0 for those with no abnormal indices.ResultsWe found that higher F-NLR scores were associated with larger tumor size, deeper tumor invasion and more lymph node metastasis (all P<0.05). In a multivariate analysis, F-NLR independently predicted postoperative survival (P<0.001). When stratified by tumor–node–metastasis (TNM) stage, the prognostic value of F-NLR was still maintained for stages I–II (P<0.001) and stage III (P=0.003). Of note, F-NLR also effectively stratified overall survival (OS) irrespective of age, adjuvant chemotherapy administration, tumor location and histological grade (all P<0.05). Furthermore, F-NLR and TNM stratified 5-year OS from 61% (F-NLR 0) to 15% (F-NLR 2) and from 92% (stage I) to 37% (stage III), respectively. Utilizing both F-NLR and TNM, 5-year OS ranged from 93% (F-NLR 0, TNM I) to 6% (F-NLR 2, TNM III).ConclusionThe F-NLR score independently predicts outcomes in GC patients after curative surgery. Therefore, it should be implemented in routine clinical practice for identifying more high-risk patients.

Combining the Fibrinogen/Albumin Ratio and Systemic Inflammation Response Index Predicts Survival in Resectable Gastric Cancer

“…Data on the following clinicopathological characteristics were collected from medical records: sex, age, primary tumour location, differentiation, tumour size, and TNM stage. Similar to other studies [12][13][14], blood samples were obtained within 1 week before surgery for the measurement of neutrophil, lymphocyte, monocyte, platelet, albumin (Alb), and fibrinogen (Fib) levels. Patients meeting any of the following criteria were excluded: (1) histologically confirmed stage IV disease, (2) severe complications or death within 15 days after diagnosis, (3) incomplete pretreatment laboratory parameters, (4) malignancies other than gastric cancer, (5) haematological disorders which could potentially affect the white blood cells, and (6) evidence of any autoimmune or infectious diseases or liver dysfunction indicated by abnormal alanine aminotransferase.…”

Combination of preoperative fibrinogen concentration and neutrophil‑to‑lymphocyte ratio for prediction of the prognosis of patients with resectable breast cancer

“…Elevated fibrinogen levels are associated with poor outcomes in gynaecological cancer (23), lung cancer (24) and BC (25). Previous studies using a scoring system based on the combination of fibrinogen concentration and neutrophil-to-lymphocyte ratio (F-NLR) have reported that a high F-NLR score is associated with poor outcomes in different types of cancer (26)(27)(28)(29). However, to the best of our knowledge, the prognostic value of F-NLR in BC remains unknown.…”

<p>Prognostic Value of the Combination of CEA and Fibrinogen/Albumin Ratio in Resectable Gastric Cancer</p>

“…Previous studies have shown that increased plasma fibrinogen indicates poor prognosis of various cancers including GC. 4,5 Malnutrition is a common clinical manifestation of gastrointestinal cancers and is also a prognostic indicator of cancer. Albumin is commonly used to assess nutritional status, and hypoalbuminemia is associated with poor prognosis in several cancers such as lung, gastric, and colon cancers.…”