Fibrinogen-Albumin Ratio Index Exhibits Predictive Value of Neoadjuvant Chemotherapy in Osteosarcoma

Zhendong Li; Chenliang Zhou; Qing Peng; Suguo Wang; Guowei Qian; Lina Tang; Xin Zhou; Qingcheng Yang; Zan Shen; GaoZhong Huang; Yonggang Wang; Hongtao Li

doi:10.2147/CMAR.S358310

Fibrinogen-Albumin Ratio Index Exhibits Predictive Value of Neoadjuvant Chemotherapy in Osteosarcoma

Cancer Manag Res. 2022 May 5:14:1671-1682. doi: 10.2147/CMAR.S358310. eCollection 2022.

Authors

Zhendong Li^#¹, Chenliang Zhou^#², Qing Peng^#³, Suguo Wang³, Guowei Qian², Lina Tang², Xin Zhou⁴, Qingcheng Yang¹, Zan Shen², GaoZhong Huang³, Yonggang Wang², Hongtao Li²

Affiliations

¹ Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
² Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
³ Department of VIP Clinic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
⁴ Cancer Research Institute of Jilin University, the First Hospital of Jilin University, Changchun, Jilin, 130021, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Inflammatory response and nutritional status are associated with cancer development and progression. The present study aimed to evaluate the predictive ability of the fibrinogen-albumin ratio index (FARI) to the efficacy of neoadjuvant chemotherapy (NAC) for osteosarcoma.

Patients and methods: A retrospective analysis involving 752 consecutive osteosarcoma patients between 2012 and 2020 was performed. Data on serum fibrinogen, albumin levels, white blood cell count, platelet count, and alkaline phosphatase (ALP) before and after NAC were collected. The predictive value of the NAC efficacy in osteosarcoma was assessed by constructing a receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Prognosis and its predictive factors were analyzed by Kaplan-Meier method and COX regression analysis. Nomogram was established according to selected variables. The predictive performance of the nomogram model was assessed using C-statistics.

Results: A total of 203 patients were included. ROC analysis showed that both FARI before NAC (preFARI; AUC = 0.594, p = 0.032) and the change in FARI before and after NAC (dfFARI = preFARI-postFARI; AUC = 0.652, p = 0.001) exhibited more favorable predictive ability than ALP and other inflammation markers. The preFARI was divided into the high group (>6.1%) and the low group (≤6.1%) based on the optimal cut-off value of 6.1%. Patients with a high preFARI showed significantly decreased metastasis-free survival (MFS) and disease-free survival (DFS) (all p<0.01). In multivariable analysis, preFARI was an independent prognostic marker for patients with osteosarcoma. Predictive nomograms exhibited good ability to predict MFS (C-index = 0.748, se = 0.028) and DFS (C-index=0.727, se = 0.030).

Conclusion: Our findings indicated that FARI exhibits the favorable predictive ability for the efficacy of NAC for osteosarcoma, which could support clinicians and patients in clinical decision-making and treatment optimization.

Keywords: albumin; fibrinogen; fibrinogen–albumin ratio index; neoadjuvant chemotherapy; osteosarcoma; prognosis.

Grants and funding

This work was supported by China Medicine Education Association (CMEA) (No. 2020KTS012), the National Natural Scientific Foundation of China (NSFC) (No. 82002962; 81900189). The funder has no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.