Diagnostic value of fibrinogen to prealbumin ratio and gamma-glutamyl transpeptidase to platelet ratio in the progression of AFP-negative hepatocellular carcinoma

Abstract

Background: This study aimed to comprehensively assess the diagnostic value of fibrinogen to prealbumin ratio (FPR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) as single markers or in combination in patients with alpha-fetoprotein-negative (AFP-negative) hepatocellular carcinoma (HCC). Methods: A total of 199 healthy controls and 515 AFP-negative patients were enrolled in this study, including 180 HCC inpatients, 151 liver cirrhosis (LC) patients, and 184 chronic hepatitis (CH) cases. Mann-Whitney U or Kruskal-Wallis H test were used to analyze differences between groups in laboratory parameters and clinicopathological features. The diagnostic value of FPR and GPR, alone or in combination, in AFP-negative HCC (AFP-NHCC) patients was determined via a receiver operating characteristic (ROC) curve. Results: The levels of FPR and GPR were gradually increased in the development of AFP-NHCC and positively correlated with the tumor size and Barcelona Clinic Liver Cancer (BCLC) stages. Moreover, GPR was associated with Edmondson-Steiner grades. After univariate logistic regression analysis, FPR and GPR remained independent predictors of adverse outcomes. The combination of FPR and GPR had a good ability to detect AFP-NHCC from the control group (area under curve [AUC] = 0.977), AFP-negative CH (AUC = 0.745), and AFP-negative LC (AUC = 0.666). FPR combined with GPR possessed a larger area (0.943, 0.971) and sensitivity (87.50%, 89.81%) than FPR or GPR alone for differentiating AFP-NHCC with tumor size < 3 cm or at the BCLC-A stage. Conclusions: The pretreatment levels of FPR and GPR played vital roles in the development of AFP-NHCC, especially in patients with early or small AFP-NHCC.

Prognostic Significance of Preoperative Fibrinogen-to-Prealbumin Ratio in Patients with Stage I–III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study

“…Correlation analysis results showed that high FPR was associated with low BMI, advanced age, and colon tumors, indicating that an increase in FPR may reflect the poor physical condition and nutritional status of patients. In addition, FPR is also correlated with tumor size and vascular invasion, suggesting that this biological indicator may be related to the aggressive cancer phenotype, which is consistent with previous studies [ 9 , 34 ]. The relationship between FPR and complications was also assessed for the first time, revealing that patients with a high FPR had a higher incidence of complications, while high FPR was an independent risk factor for complications.…”

“…It has been recently reported that fibrinogen-to-prealbumin ratio (FPR) can be utilized to predict the prognosis of various malignancies, such as hepatocellular carcinoma, gastric cancer, and esophageal cancer [ 9 – 13 ]. Fibrinogen can promote the synthesis of proinflammatory cytokines and fibroblast growth factors, induce malignant tumor cell proliferation, promote tumor angiogenesis, and participate in cell responses related to tumor cell adhesion and migration [ 14 , 15 ].…”

A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy

“…Carr et al found that patients with significantly high GGT values were prone to poor overall survival in cases of low AFP HCC [ 44 ]. The results of this study and previous studies indicate that the increase of γ-GGT is closely related to the prognosis of patients with AFP-NHCC [ 15 , 45 ]. Anemia is common in cancer patients.…”

New Blood Biomarkers for the Diagnosis of AFP-Negative Hepatocellular Carcinoma

“…Moreover, low levels of pre-albumin and high levels of D-Dimer were independent predictors of an unfavorable outcome for ANHC ( 7 ). Huang et al ( 171 ) also found that the combination of fibrinogen to pre-albumin ratio and gamma-glutamyl transpeptidase to platelet ratio had a good ability to detect ANHC from the control group (AUROC = 0.977), AFP-negative chronic hepatitis (AUC = 0.745), and AFP-negative LC (AUC = 0.666) and possessed a larger area (0.943, 0.971) than fibrinogen to pre-albumin ratio and gamma-glutamyl transpeptidase to platelet ratio alone for differentiating small or early ANHC.…”