Combination of Preoperative Plasma Fibrinogen and Neutrophil‐to‐Lymphocyte Ratio (the F‐NLR Score) as a Prognostic Marker of Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy

Abstract

Background Coagulation and inflammation play important roles in tumor progression. This study aimed to explore the prognostic impact of combined analysis of fibrinogen and neutrophil‐to‐lymphocyte (NLR) ratio (F‐NLR score) in locally advanced rectal cancer (LARC) receiving preoperative chemoradiotherapy (pCRT) and radical surgery. Method Totally 317 patients were included. X‐tile analysis was used to determine the optimal cutoff values of preoperative fibrinogen and NLR. F‐NLR scores were defined as 2 (both high fibrinogen and NLR), 1 (one of these abnormalities), or 0 (neither abnormality). Time‐dependent ROC analysis was used to evaluate the predictive accuracy of fibrinogen, NLR, and F‐NLR score. Cox regression analysis was performed to evaluate the prognostic impact of the F‐NLR score. A predictive nomogram for disease‐free survival (DFS) was developed and validated internally. Results One hundred and seventeen (36.9%), 156 (49.2%), and 44 (13.9%) patients had F‐NLR score of 0, 1, and 2, respectively. Higher F‐NLR score was associated with poorly differentiated tumors, deeper tumor invasion, lymph node metastasis, and more advanced pTNM stage (all P < 0.05). The 5‐year OS rates in the F‐NLR 0, 1, and 2 groups were 93.6%, 87.3%, and 68.4%, respectively (P < 0.001), while the 5‐year DFS rates were 91.8%, 76.8%, and 56.1%, respectively (P < 0.001). Cox regression analysis demonstrated that F‐NLR score (F‐NLR 1, HR = 2.021, P = 0.046; F‐NLR 2, HR = 3.356, P = 0.002), pTNM stage III (HR = 3.109, P = 0.009), and circumferential resection margin (CRM) involvement (HR = 3.120, P = 0.021) were independently associated with DFS. A nomogram for DFS was developed (C‐index 0.708). Conclusion F‐NLR score is a promising predictor for disease recurrence in LARC patients after pCRT.

Fibrinogen/Albumin Ratio as a Promising Marker for Predicting Survival in Pancreatic Neuroendocrine Neoplasms

“…Many studies have shown that an elevated FAR is closely related to a poor prognosis in various cancers. 37 To the best of our knowledge, our study is the first to report on the prognostic role of the FAR in Pan-NENs.…”

Nomograms for predicting specific distant metastatic sites and overall survival of colorectal cancer patients: A large population‐based real‐world study

“…For instance, a combination of clinical risk factors and radiomics features emphasized potential advantages to the individualized preoperative prediction of lymph node metastasis in CRC patients, which was proposed to benefit patient OS. Sun et al argued that the fibrinogen and neutrophil‐to‐lymphocyte ratio (F‐NLR score) is a promising predictor for disease relapse in rectal cancer patients 25,26 . The dissertations mentioned above were dedicated to predicting the preoperative or postoperative conditions of patients, and both might improve the prognosis of patients.…”

Clinical parameters predictive for sphincter-preserving surgery and prognostic outcome in patients with locally advanced low rectal cancer

“…Second, the distance of the lower tumor margin to the anal verge is undoubtedly an important independent factor for the determination of sphincterpreserving procedure. According to Sun et al rectal cancer with a distance of the tumor from the anal verge of > 5 cm was shown to have a significant higher rate of sphincter-preservation [13]. Due to conflicting results between pre-treatment CT, MRT and rigid proctoscopy we decided not to incorporate the distance to the anal verge exactly.…”

“…In multiple studies [7,8,13], the serum fibrinogen value proved to be a promising independent predictor of the therapeutic response and the prognosis after nRCT. Until now, we have not had any data to show whether this parameter also influences the sphincter-preserving surgery rate.…”

“…There is a growing body of data that describe a relationship between tumor associated parameters and the tumor response. The most promising parameters are the tumor marker carcinoembryonic antigen (CEA), fibrinogen, genetic polymorphisms in epithelial growth factor receptor (EGFR) and thymidylate synthase (TS), bcl-2/ bax and cyclooxygenase (COX)-2, clinical T-size, statin use, and the distance of the primary tumor from the anal verge [4,[6][7][8][9][10][11][12][13]. However, it remains unclear how these parameters can be used to predict the tumor response in clinical routine.…”