Predictive Value of Preoperative Fibrinogen and Albumin Score (FA Score) for Prognosis and Chemotherapeutic Efficacy in Resected Colorectal Cancer: A Retrospective Cohort Study

Abstract

Background: Limited research elucidated the role of preoperative fibrinogen and albumin (FA) score in colorectal cancer (CRC). We aimed to clarify the predictive value of FA score for prognosis and chemotherapeutic efficacy in CRC patients who underwent curative resection. Materials and Methods: Patients' clinicopathological parameters of 735 cases of resected CRC were recruited retrospectively. Optimal cut-off values of the preoperative plasma fibrinogen (F) and albumin (A) were confirmed by receiver operating characteristic (ROC) curves. Patients were categorized into three groups based on the FA score, and were further divided into a chemotherapy group and a non-chemotherapy group. Correlations between FA score and clinicopathological features, as well as overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were assessed with Kaplan-Meier (KM) survival method, univariate and multivariate Cox proportional hazard models, and subgroup analyses. Results: The Kaplan-Meier survival curves revealed that higher FA score could predict poorer OS and CSS (P<0.001). Multivariate analyses revealed that FA score was an independent prognostic factor for OS (P=0.037). In addition, subgroup analyses based on the histological feature and primary tumor location showed that elevated FA score was significantly associated with worse OS, CSS and DFS (all, P<0.05) in patients with non-mucinous colorectal adenocarcinoma and rectal cancer (RECC). Subgroup analyses based on the TNM stage showed that elevated FA score was significantly associated with worse OS, CSS (all, P<0.05) in patients with TNM stage II tumors. Furthermore, chemotherapy could benefit the OS and CSS in TNM stage III CRC patients with FA score 1 and 2 (all, P<0.05). Conclusion: The preoperative FA score is an independent prognostic factor for CRC patients who underwent curative resection and may help predict the responses to chemotherapy in clinical practice. FA score may serve as a complementary to the TNM staging system to identify high-risk patients.

Keywords: albumin; colorectal cancer; fibrinogen; prognosis, chemotherapeutic efficacy.

Figure 1

ROC curves to assess the predictive value of plasma fibrinogen and albumin. Notes: The cut-off values were 3.615 for fibrinogen and 41.550 g/L for albumin, respectively. The AUC values were 0.5827 for fibrinogen and 0.5748 for albumin, respectively. Abbreviations: FIB, fibrinogen; ALB, albumin; ROC, receiver operating characteristic. AUC, area under the curve.

Figure 2

Kaplan-Meier survival curves for OS according to the FA score (A) and subgroup analysis based on histological features (B) and primary tumor location (C) and TNM stage (D). Abbreviations: FA score, combined fibrinogen and albumin; OS, overall survival.

Figure 3

Kaplan-Meier survival curves for CSS according to the FA score (A) and subgroup analysis based on histological features (B) and primary tumor location (C) and TNM stage (D). Abbreviations: FA score, combined fibrinogen and albumin; CSS, cancer-specific survival.

Figure 4

Kaplan-Meier survival curves for DFS according to the FA score (A) and subgroup analysis based on histological features (B) and primary tumor location (C) and TNM stage (D). Abbreviations: FA score, combined fibrinogen and albumin; DFS, disease-free survival.

Figure 5

Kaplan-Meier survival curves based on chemotherapy or not in patients with different TNM stages and FA scores. (A) OS. (B) CSS. (C) DFS. Abbreviations: FA score, combined fibrinogen and albumin; OS, overall survival; CSS, cancer-specific survival; DFS, disease-free survival.