Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7382-7404
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7382
Prognostic value of the preoperative fibrinogen-to-albumin ratio in pancreatic ductal adenocarcinoma patients undergoing R0 resection
Li-Peng Zhang, Hu Ren, Yong-Xing Du, Cheng-Feng Wang
Li-Peng Zhang, Hu Ren, Yong-Xing Du, Cheng-Feng Wang, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Cheng-Feng Wang, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Zhang LP was involved in study concept, data analysis, and production of tables, wrote the first draft, and revised it critically in light of comments from other authors; Ren H and Du YX helped to collect the clinical data and followed up with the patients; Wang CF was involved in study conception and design, data interpretation, manuscript revision, and discussion; all authors approved the final version submitted.
Supported by National Natural Science Foundation of China, No. 81972314; and Innovation Fund for Medical Sciences of Chinese Academy of Medical Sciences, No. 2016-I2M-1-001.
Institutional review board statement: The study was reviewed and approved by The National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.
Informed consent statement: All patients and their families signed informed consent statements before surgery, and the type of surgical procedure was performed according to the authoritative guidelines.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Feng Wang, MD, Chief Doctor, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. ywwangchengfeng@163.com
Received: September 23, 2020
Peer-review started: September 23, 2020
First decision: October 27, 2020
Revised: October 29, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: December 14, 2020
Processing time: 82 Days and 4.7 Hours
ARTICLE HIGHLIGHTS
Research background

Pancreatic cancer has the worst prognosis of all the malignancies, with only 20% of pancreatic cancer patients having access to surgical treatment. The poor prognosis of pancreatic cancer patients is related to the early asymptomatic nature of the disease, leading to the late stage of disease diagnosis and the high possibility of distant metastasis in the early stage of pancreatic cancer. Inflammation plays an important role in tumor progression, and growing evidence has confirmed that the fibrinogen-to-albumin ratio (FAR) is an important prognostic factor for overall survival (OS) in malignant tumors.

Research motivation

We speculate that FAR, as an easily available, cost-effective, and noninvasive prognostic indicator for pancreatic cancer patients, could help to select and identify pancreatic cancer patients suitable for surgical resection. This will benefit pancreatic cancer patients.

Research objectives

The main objective of our study was to investigate the prognostic significance of FAR in pancreatic ductal adenocarcinoma (PDAC) patients undergoing radical R0 resection.

Research methods

A total of 282 PDAC patients undergoing radical R0 resection were included in this retrospective study. We used the surv_cutpoint function and receiver operating characteristic curves to determine the optimal cut-off values for preoperative fibrinogen, albumin, and FAR. We analyzed the patients’ clinicopathological data, the Kaplan-Meier method and log-rank tests were used for univariate survival analysis, and a Cox regression model was used for multivariate survival analysis for these patients.

Research results

The optimal cut-off value of FAR was 0.08 in our study. Higher preoperative FAR was significantly correlated with clinical symptoms, tumor location, surgical approaches, preoperative plasma fibrinogen concentration, and preoperative plasma albumin level (all P < 0.05). Multivariate analysis showed that preoperative FAR (HR: 2.258, 95%CI: 1.720-2.963, P < 0.001) was an independent prognostic factor in PDAC patients undergoing radical R0 resection.

Research conclusions

Preoperative FAR, as an indicator that reflects the ratio between the fibrinogen concentration and albumin level, is an important predictor of the OS in PDAC patients undergoing radical R0 resection. A higher preoperative FAR predicted poor prognosis in these patients.

Research perspectives

In the future, it is necessary to design more multicenter, prospective studies with a large sample to verify the current conclusions. Additionally, more basic experiments exploring the potential mechanisms are necessary.