Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2023; 15(9): 1662-1672
Published online Sep 15, 2023. doi: 10.4251/wjgo.v15.i9.1662
Fibrinogen-to-albumin ratio predicts overall survival of hepatocellular carcinoma
Hao Sun, Jie Ma, Jian Lu, Zhi-Hong Yao, Hai-Liang Ran, Hai Zhou, Zhong-Qin Yuan, Yun-Chao Huang, Yuan-Yuan Xiao
Hao Sun, Hai-Liang Ran, Yuan-Yuan Xiao, NHC Key Laboratory of Drug Addiction Medicine, School of Public Health, Kunming Medical University, Kunming 650500, Yunnan Province, China
Jie Ma, Jian Lu, Zhi-Hong Yao, Hai Zhou, Zhong-Qin Yuan, Yun-Chao Huang, The Third Affiliated Hospital, Kunming Medical University, Kunming 650500, Yunnan Province, China
Author contributions: All authors contributed to the conception and design of the study; the data extraction conditions were determined by Huang YC and Xiao YY; data extraction was performed by Sun H, Ma J, Lu J, Yao ZH, Zhou H, Yuan ZQ; data analysis plan was determined by Xiao YY, and data analysis was performed by Sun H, Ma J, Tan HL; the first draft of the manuscript was written by Sun H and Ma J, and all the authors commented on the previous versions of the manuscript; all authors have read and approved the final manuscript.
Supported by the Basic Research Program of Yunnan, No.202201AT070200; the Top Young Talents of Yunnan Ten Thousand Talents Plan, No. YNWR-QNBJ-2018-286.
Institutional review board statement: The study protocol was approved by the Ethics Review Committee of Kunming Medical University.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: Database of this manuscript can be available from the corresponding author under reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Yuan Xiao, PhD, Professor, NHC Key Laboratory of Drug Addiction Medicine, School of Public Health, Kunming Medical University, No.1168 West Chunrong Road, Yuhua Street, Chenggong District, Kunming 650500, Yunnan Province, China. 33225647@qq.com
Received: May 31, 2023
Peer-review started: May 31, 2023
First decision: July 23, 2023
Revised: August 4, 2023
Accepted: August 18, 2023
Article in press: August 18, 2023
Published online: September 15, 2023

Fibrinogen-to-albumin ratio (FAR) has been found to be of prognostic significance for several types of malignant tumors. However, less is known about the association between FAR and survival outcomes in hepatocellular carcinoma (HCC) patients.


To explore the association between FAR and prognosis and survival in patients with HCC.


A total of 366 histologically confirmed HCC patients diagnosed between 2013 and 2018 in a provincial cancer hospital in southwestern China were retrospectively selected. Relevant data were extracted from the hospital information system. The optimal cutoff for baseline serum FAR measured upon disease diagnosis was established using the receiver operating characteristic (ROC) curve. Univariate and multivariate Cox proportional hazards models were used to determine the crude and adjusted associations between FAR and the overall survival (OS) of the HCC patients while controlling for various covariates. The restricted cubic spline (RCS) was applied to estimate the dose-response trend in the FAR-OS association.


The optimal cutoff value for baseline FAR determined by the ROC was 0.081. Multivariate Cox proportional hazards model revealed that a lower baseline serum FAR level was associated with an adjusted hazard ratio of 2.43 (95% confidence interval: 1.87–3.15) in the OS of HCC patients, with identifiable dose-response trend in the RCS. Subgroup analysis showed that this FAR-OS association was more prominent in HCC patients with a lower baseline serum aspartate aminotransferase or carbohydrate antigen 125 level.


Serum FAR is a prominent prognostic indicator for HCC. Intervention measures aimed at reducing FAR might result in survival benefit for HCC patients.

Keywords: Fibrinogen-to-albumin ratio, Hepatocellular carcinoma, Overall survival, Survival analysis, Cox proportional hazards model

Core Tip: It is important to explore the affecting factors of survival for hepatocellular carcinoma (HCC) patients. A receiver operating characteristic curve was used to establish the optimal cutoff value for baseline serum fibrinogen-to-albumin ratio (FAR) in disease diagnosis. Univariate and multivariate Cox proportional risk models were employed to determine the correlation between FAR and overall survival (OS) in HCC patients. Restricted cubic spline was used to estimate dose-response trends in FAR-OS associations. Serum FAR is an important prognostic index of HCC. Effective FAR reduction may benefit HCC patient survival.