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

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

Chengqing Li  1 , Zhiyao Fan  1 , Wenyi Guo  1 , Feng Liang  2 , Xincheng Mao  3 , Jiahao Wu  1 , Haodong Wang  1 , Jianwei Xu  1 , Dong Wu  1 , Han Liu  1 , Lei Wang  1 , Feng Li  1
Affiliations

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

Chengqing Li et al. Front Oncol. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flowchart of enrolled patients.
Figure 2
Figure 2
Kaplan–Meier curves of overall survival in patients with resectable pancreatic cancer stratified by fibrinogen-to-prealbumin ratio. (A) Total cohort (B) Training cohort (C) Validation cohort.
Figure 3
Figure 3
Variable selection using the least absolute shrinkage and selection operator (LASSO) regression model. (A) Coefficient profiles plot (B) Optimum parameter (lambda) selection.
Figure 4
Figure 4
Survival nomogram for patients with resectable pancreatic cancer. To use the nomogram, an individual’s value is located on each variable axis, and a line is drawn upward to determine the number of points received for each variable. The sum of these numbers is located on the total points axis, and a line is drawn downward to the survival axes to determine the likelihood of survival at 1 year, 1.5 year and 2 years. FPR, fibrinogen-to-prealbumin ratio; CA, carbohydrate antigen; CEA, carcinoembryonic antigen; AJCC, American Joint Committee on Cancer; TNM, tumor node metastasis.
Figure 5
Figure 5
The calibration curve of the nomogram for 1-year, 1.5-year and 2-year survival of patients with resectable pancreatic cancer in the training cohort (A–C) and validation cohort (D–F). OS, overall survival.
Figure 6
Figure 6
The decision curve analysis of the nomogram for 1-year, 1.5-year and 2-year survival of patients with resectable pancreatic cancer in the training cohort (A–C) and validation cohort (D–F). TNM: tumor node metastasis.
Figure 7
Figure 7
Time-dependent AUC plot for survival prediction in the training cohort (A) and validation cohort (B). TNM, tumor node metastasis.
Figure 8
Figure 8
Risk stratification of nomogram model for patients with resectable pancreatic cancer in the training cohort (A) and validation cohort (B).
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