Albumin‐to‐fibrinogen ratio as a promising biomarker to predict clinical outcome of non‐small cell lung cancer individuals

Abstract

Chronic inflammation is one of the critical causes to promote the initiation and metastasis of solid malignancies including lung cancer (LC). Here, we aimed to investigate the prognostic roles of albumin (Alb)‐to‐fibrinogen (Fib) ratio (AFR), Fib and Alb in LC and to establish a novel effective nomogram combined with AFR. Four hundred twelve LC patients diagnosed between February 2005 and December 2014 were recruited in this prospective study. The prognostic roles of AFR, Fib, Alb, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR) and monocyte‐to‐lymphocyte ratio (MLR) were identified by X‐tile software, Kaplan–Meier curve, Cox regression model, and time‐dependent ROC. Pretreatment high circulating Fib, low AFR, and Alb were significantly associated with increased risk of death for LC patients, especially for non‐small cell lung cancer (NSCLC) patients in all stages. The area under curves (AUCs) of AFR, Fib, and NLR were higher than them within Alb and PLR for predicting the survival of NSCLC patients. Moreover, we found that clinical outcome of high AFR patient with chemo‐radiotherapy was superior to low AFR patient; overall survival rate of stage II‐III NSCLC patients undergoing chemo‐radiotherapy was significantly lower than the surgical patients with treatment of adjuvant chemo‐radiotherapy(P = 0.001) in low AFR subgroup. On the contrary, clinical outcome of the patients receiving chemo‐radiotherapy was the same to the patients undergoing surgery and adjuvant chemo‐radiotherapy (P = 0.405) in high AFR subgroup. In addition, c‐index of predicted nomogram including AFR (0.717) for NSCLC patients with treatment of chemo‐radiotherapy was higher than that without AFR (0.707). Our findings demonstrated that circulating pretreatment AFR might be a potential biomarker to predict clinical efficacy of surgical resection and adjuvant chemo‐radiotherapy and be a prognostic biomarker for NSCLC individuals.

Karotis endarterektomili ve şiddetli olmayan karotis arter darlığı olan hastalarda fibrinojen / albümin oranı ve karotis arter hastalığı arasındaki ilişki.

“…Cho et al [15] in the study that was assessed Recently, the association of fibrinogen and albumin started to be investigated in coronary artery disease and in many cancer cases. In many cancer diseases such as hepatocellüler ca [17], breast ca [19], non-squamöz eausofagial ca [20] and lung ca [21], fibrinogen to albumin ratio was calculated and high FAR was associated with bad prognosis. In one of the rare studies on the rate of fibrinogen albumin in coronary artery disease, Karahan et al [22] showed that FAR is significantly related to SYNTAX Score in predicting the severity of CAD in patients with ST-elevation myocardial infarction.…”

Circulating Fibrinogen to Pre-albumin Ratio for Chemotherapy Efficacy Prediction and Prognosis of Colorectal Cancer Patients

“…Conversely, a dynamic alteration of circulating acute phase reaction proteins, such as brinogen (Fib), albumin (Alb) and pre-albumin (pAlb), has been implicated in prolonged in ammation and disease elevation. In fact, previous studies have demonstrated that ratios of Alb to Fib (AFR) and Fib to pAlb (FPR) are independent markers for predicting clinical outcomes in many kinds of solid malignancies, including non-small cell lung cancer [16], esophageal, hepatocellular and gastric cancers [17][18][19]. In our previous study, we demonstrated that preoperative FPR is closely associated with chemoresistance and outcomes of metastatic CRC [20].…”

<p>Low Albumin to Fibrinogen Ratio Predicts Poor Overall Survival in Esophageal Small Cell Carcinoma Patients: A Retrospective Study</p>

“…Actually, some investigators have reported that pretreatment AFR could serve as a promising biomarker to predict survival in several cancers such as the non-small cell lung cancer (NSCLC), breast cancer, squamous cell carcinoma of esophagus (SCCE) and hepatocellular carcinoma and low AFR predicts poorer survival for cancer patients. [7][8][9][10] Albumin and fibrinogen are both inflammatory and immunological proteins which involve in the initiation, growth and metastasis of tumors. 7 Hence, we hypothesized that circulating AFR could serve as an effective indicator to predict the prognosis and contribute to the formulation of therapeutic strategy for ESCC patients.…”

“…[7][8][9][10] Albumin and fibrinogen are both inflammatory and immunological proteins which involve in the initiation, growth and metastasis of tumors. 7 Hence, we hypothesized that circulating AFR could serve as an effective indicator to predict the prognosis and contribute to the formulation of therapeutic strategy for ESCC patients.…”