Preoperative Fibrinogen Albumin Ratio is an Effective Biomarker for Prognostic Evaluation of Gallbladder Carcinoma After Radical Resection: A 10-Year Retrospective Study at a Single Center

Qi Li; Jian Zhang; Qi Gao; Jialu Fu; Mengke Li; Hengchao Liu; Chen Chen; Dong Zhang; Zhimin Geng

doi:10.2147/JIR.S399586

Preoperative Fibrinogen Albumin Ratio is an Effective Biomarker for Prognostic Evaluation of Gallbladder Carcinoma After Radical Resection: A 10-Year Retrospective Study at a Single Center

J Inflamm Res. 2023 Feb 18:16:677-689. doi: 10.2147/JIR.S399586. eCollection 2023.

Authors

Qi Li¹, Jian Zhang¹, Qi Gao¹, Jialu Fu^{1

2}, Mengke Li¹, Hengchao Liu¹, Chen Chen¹, Dong Zhang¹, Zhimin Geng¹

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
² Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.

Abstract

Background: To explore and screen preoperative serum immune response level-related biomarkers with better prognostic ability and developed a prognostic model for decision-making in clinical practice for gallbladder carcinoma (GBC) patients.

Methods: A total of 427 patients who underwent radical resection for GBC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Time-dependent receiver operating characteristic (time-ROC) was performed to determine the prognostic predictive power of preoperative biomarkers. A nomogram survival model was established and validated.

Results: Time-ROC indicated that the preoperative fibrinogen-to-albumin ratio (FAR) had a better predictive ability for overall survival among preoperative serum immune response level-related biomarkers. Multivariate analysis indicated that FAR was an independent risk factor (P<0.05). The proportion of clinicopathological characteristics of poor prognosis (such as advanced T stage, and N1-2 stage) was significantly higher in high FAR group (P<0.05). Subgroup analyses indicate the prognostic discrimination ability of FAR depended on CA19-9, CA125, liver involvement, major vascular invasion, perineural invasion, T stage, N stage, and TNM stage (all P <0.05). A nomogram model was established based on the prognostic independent risk factors with the C-index of 0.803 (95% CI:0.771~0.835) and 0.774 (95% CI:0.696~0.852) in the training and testing sets, respectively. The decision curve analysis indicated the nomogram model had a better predictive ability than the FAR and TNM staging system in the training and testing sets.

Conclusion: Preoperative serum FAR has a better predictive ability for overall survival among preoperative serum immune response level-related biomarkers, and it can be used for survival assessment of GBC and guide clinical decision-making.

Keywords: fibrinogen to albumin ratio; gallbladder carcinoma; inflammation; nomogram; prognosis.

Grants and funding

Supported by the National Natural Science Foundation of China (No. 62076194); Key Research and Development Program of Shaanxi Province (2021-SF-016, 2022-SF-410, and 2022-SF-606); Clinical Research Fund of the First Affiliated Hospital of Xi’an Jiaotong University (No. XJTU1AF-CRF-2018-022).