Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy

Abstract

Background A high prevalence of postoperative complications is closely associated with a worse short- and long-term outcome. This current study aimed to investigate potential risk factors including albumin-to-fibrinogen ratio (AFR) for severe postoperative complications (SPCs) in surgical gastric cancer (GC) patients. Methods Elderly patients (≥65 years) with primary GC who underwent elective radical laparoscopic gastrectomy under general anesthesia were included. According to the Clavien–Dindo classification system, the severity of complications was assessed from Grade I to V and SPCs were defined as C-D Grade ≥ IIIa. The clinicopathological features, operative-associated characteristics, postoperative recovery and laboratory tests were compared between patients with or without SPCs. Receiver operating characteristic (ROC) curve analysis using Youden’s Index was established for determining the predictive value and cut-off threshold of AFR for SPCs. Binary univariate and multivariate logistic regression models were used to assess factors influencing SPCs. Results A total of 365 elderly GC patients were finally included in the analysis, of which 52 (52/365, 14.2%) patients had developed SPCs within postoperative 30 days. Preoperative AFR level predicted SPCs in surgical GC patients with an AUC of 0.841, a sensitivity of 76.36% and a specificity of 80.77%, respectively (P < 0.001). The multivariate analysis revealed that a lower AFR level (OR: 1.94, 95% CI: 1.09–3.36, P = 0.017) and an older age (OR: 1.81, 95% CI: 1.06–3.04, P = 0.023) were two independent predictive factors for SPCs in surgical GC patients. Conclusions Preoperative AFR level is a useful predictor for SPCs in elderly GC subjects after radical laparoscopic gastrectomy.

Diagnostic Value of Albumin to Fibrinogen Ratio in Cervical Cancer

“…As a valuable indicator, AFR or fibrinogen to albumin ratio (FAR), was applied to assess the systemic inflammatory response (SIR) and/or nutrition status in many cancers and other serious diseases. 13,18,22,23 The diagnostic and clinicopathological value of AFR has been reported in numerous cancers. Li et al 24 reported that AFR was a prospective biomarker to predict tumor size and clinical outcome in non-small cell lung cancer.…”

“…6,7 Research on inflammation and inflammatory mediators has revealed that inflammation markers can trigger a premetastatic niche to escape the immunological surveillance and to play decisive roles at every step of tumorigenesis and development. 8 These inflammatory molecules-such as neutrophils, 9 platelets, 10 lymphocytes, 11 fibrinogen (Fib), 12 albumin (Alb), 13 and combinations of several single markers in the forms of ratios, 14,15 which are usually derived from circulating immune cells and acute-phase reactive proteins-have been reported as valuable predictors in a variety of human tumors. Currently, many studies have applied these routine parameters for the diagnosis and prognosis of malignant tumors.…”

Prognostic value of fibrinogen‑to‑albumin ratio in patients with gastric cancer receiving first‑line chemotherapy

“…Analysis of existing data has demonstrated that conditions of hypercoagulability, inflammation and poor nutritional status are independent prognostic factors for poor prognosis of patients with GC. As a marker reflecting coagulation function nutritional and the inflammatory status of patients, several studies have used the fibrinogen-to-albumin ratio (FAR) or albumin-to-fibrinogen ratio (AFR) to evaluate the prognosis of various cancer patients, including those with GC, and have found that increased FAR or decreased AFR levels were associated with poor prognosis in cancer patients (12)(13)(14)(15)(16)(17). Another critical role of FAR or AFR is to assess the effect of the chemotherapy regimen in a particular population to guide the selection of an optimal therapy (18)(19)(20).…”

Prealbumin-to-Globulin Ratio Can Predict the Chemotherapy Outcomes and Prognosis of Patients with Gastric Cancer Receiving First-Line Chemotherapy

“…Multiple studies have investigated a series of inflammatory and nutritional markers available to doctors, including the PGR, AGR, FAR, PLR, NLR, and LMR, for the prognosis of patients with different types of cancer [18,[22][23][24][25][26]. Among them, the AGR, FAR, PLR, NLR, and LMR were frequently applied to anticipate complications and the prognosis of patients with GC [27][28][29][30][31]. However, there is scant evidence on the relationship between the PGR and the prognosis of patients with GC.…”