Fibrinogen/albumin ratio as a promising predictor of platinum response and survival in ovarian clear cell carcinoma

Abstract

Background: This study aims to evaluate the role of the fibrinogen/albumin ratio (FAR) in predicting platinum resistance and survival outcomes of patients with ovarian clear cell carcinoma (OCCC).

Methods: Coagulation function and D-dimer, serum albumin, CA125 and HE4 levels were measured before surgery in OCCC patients undergoing initial surgery in our institution. FAR was calculated as fibrinogen/albumin level. The correlation between these indicators and clinicopathological features, platinum response, and survival outcomes was further analyzed. The Kaplan-Meier method and multivariable Cox regression model were used to assess the effects of FAR on progression-free survival (PFS) and overall survival (OS).

Results: Advanced stage patients accounted for 42.1% of the 114 participants. Optimal cytoreductive surgery was achieved in 105 patients, and the complete resection rate was 78.1%. FAR was associated with tumor stage, residual tumor and platinum response. A receiver operating characteristic curve for predicting platinum response showed that the optimal cutoff point of the FAR was 12%. The sensitivity was 73.3% and the specificity was 68.2%. In multivariate analysis, FAR ≥12% (HR = 4.963, P = 0.002) was an independent risk factor for platinum resistance. In addition, FAR and D-dimer proved to be independent negative factors for outcomes including both PFS and OS. The median follow-up time was 52 months. A high FAR (≥ 12%) showed a stronger correlation with poor OS and PFS in the subgroup analysis of advanced and completely resected patients.

Conclusions: The FAR might be a potential preoperative biochemical marker for predicting treatment response and oncological outcomes in OCCC patients.

Keywords: Clear cell carcinoma; Fibrinogen/albumin ratio; Ovarian neoplasms; Platinum resistance; Survival.

Fig. 1

Flow chart illustrating the patient inclusion

Fig. 2

Differential expression of fibrinogen/albumin ratio in patients with different FIGO stages, platinum response, and residual tumour. (Abbreviations: S, platinum-sensitive; R, platinum resistance)

Fig. 3

Receiver operating characteristic curve demonstrating the AUC of preoperative FAR for platinum resistance, PFS and OS. (Abbreviations: AUC, area under the curve; FAR, fibrinogen/albumin ratio; OS, overall survival; PFS, progression-free survival)

Fig. 4

Kaplan-Meier curves of PFS and OS for all patients stratified into two groups: patients with a FAR ≥12% and patients with a FAR < 12%

Fig. 5

Kaplan–Meier curves of PFS and OS for (A) patients without residual tumour, (B) patients with advanced-stage and (C) advanced patients without residual tumour stratified into two groups: patients with a FAR ≥12% and patients with a FAR < 12%