The role of preoperative FPR and FAR in prognostic evaluation of stages II and III radical colorectal cancer: A single-center retrospective study

Abstract

The inflammatory and nutritional states of body are 2 important causes associated with the initiation and progression of colorectal cancer (CRC). The aim of this study is to investigate the prognostic evaluation value of preoperative fibrinogen-to-prealbumin ratio (FPR) and preoperative fibrinogen-to-albumin ratio (FAR) in CRC. The clinical data of 350 stages II and III patients with CRC who received radical resection were retrospectively analyzed. All patients were followed up for 5 years to observe the overall survival and disease-free survival of 5 years and analyze the relationship between preoperative FPR and FAR and prognosis of all enrolled patients. In addition, we analyzed the diagnostic and application value of combined biomarkers. This study showed high-level preoperative FPR and FAR were significantly associated with poor overall survival and disease-free survival of stages II and III patients with CRC. The elevated preoperative FPR and FAR level was significantly related to age, tumor differentiation level, TNM stage, vascular infiltration, carcinoembryonic antigen, carbohydrate antigen199, etc. The combination of FPR, FAR, neutrophil-to-lymphocyte ratio, and carbohydrate antigen199 had the maximum area under curve (AUC = 0.856, 95% CI: 0.814-0.897, Sen = 78.20%, Spe = 82.49%, P < .05) under the receiver-operating characteristics curve. The preoperative FPR and FAR have important prognostic value and they can be used as independent prognostic marker for patients with stages II and III CRC undergoing radical resection. Moreover, the combination of biomarkers could further enhance the diagnostic and prognostic efficacy of CRC.

Figure 1.

ROC curves of FPR and FAR for CRC patients. CRC = colorectal cancer, FAR = fibrinogen-to-albumin ratio, FPR = fibrinogen-to-prealbumin ratio, ROC = receiver-operating characteristics.

Figure 2.

Kaplan–Meier survival curves of FPR and FAR for CRC patients. (A and B) OS and DFS of patients between FPR-high and FPR-low groups. (C and D) OS and DFS of patients between FAR-high and FAR-low groups. CRC = colorectal cancer, DFS = disease-free survival, FPR = fibrinogen-to-prealbumin ratio, FAR = 100 * fibrinogen-to-albumin ratio, OS = overall survival, ROC = receiver-operating characteristics.

Figure 3.

ROC curves of combined biomarkers for CRC patients. CRC = colorectal cancer, ROC = receiver-operating characteristics.