Fibrinogen-to-prealbumin ratio: A new prognostic marker of resectable pancreatic cancer

Chengqing Li; Zhiyao Fan; Wenyi Guo; Feng Liang; Xincheng Mao; Jiahao Wu; Haodong Wang; Jianwei Xu; Dong Wu; Han Liu; Lei Wang; Feng Li

doi:10.3389/fonc.2023.1149942

Fibrinogen-to-prealbumin ratio: A new prognostic marker of resectable pancreatic cancer

Front Oncol. 2023 Mar 27:13:1149942. doi: 10.3389/fonc.2023.1149942. eCollection 2023.

Authors

Chengqing Li¹, Zhiyao Fan¹, Wenyi Guo¹, Feng Liang², Xincheng Mao³, Jiahao Wu¹, Haodong Wang¹, Jianwei Xu¹, Dong Wu¹, Han Liu¹, Lei Wang¹, Feng Li¹

Affiliations

¹ Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
² Department of General Surgery, Feicheng People's Hospital, Taian, China.
³ Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.

Abstract

Background: The fibrinogen-to-prealbumin ratio (FPR), a novel immune-nutritional biomarker, has been reported to be associated with prognosis in several types of cancer, but the role of FPR in the prognosis of resectable pancreatic cancer has not been elucidated.

Methods: A total of 263 patients with resectable pancreatic cancer were enrolled in this study and were randomly divided into a training cohort (n = 146) and a validation cohort (n = 117). Receiver operating characteristic curve (ROC) was used to calculate the cut-off values of immune-nutritional markers. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression were performed in the training cohort to identify the independent risk factors, based on which the nomogram was established. The performance of the nomogram was evaluated and validation by the training and validation cohort, respectively.

Results: The optimal cutoff value for FPR was 0.29. Multivariate analysis revealed that FPR, controlling nutritional status (CONUT), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and tumor node metastasis (TNM) stage were independent predictors of overall survival (OS). The nomogram was established by involving the five factors above. The C-index of the training cohort and validation cohort were 0.703 (95% CI: 0.0.646-0.761) and 0.728 (95% CI: 0.671-0.784). Decision curve analysis and time-dependent AUC showed that the nomogram had better predictive and discriminative ability than the conventional TNM stage.

Conclusion: FPR is a feasible biomarker for predicting prognosis in patients with resectable pancreatic cancer. The nomogram based on FPR is a useful tool for clinicians in making individualized treatment strategies and survival predictions.

Keywords: fibrinogen-to-prealbumin ratio; nomogram; prognosis; resectable pancreatic cancer; tumor marker.

Grants and funding

This study was supported in part by the Natural Science Foundation of Shandong Province, China (ZR2020MH256), the Medical Health Science and Technology Project of Shandong Provincial Health Commission (2019WS386), and the National Natural Science Foundation of China (Grant No.81900731).