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Meta-Analysis
. 2025 Jun 23;23(1):248.
doi: 10.1186/s12957-025-03886-z.

Prognostic and clinicopathological value of fibrinogen-to-albumin ratio in patients with esophageal cancer: a meta-analysis

Ye Liu  1 , Xiaodi Li  2 , Xiaoli Gao  2 , Xiaoling Jin  2
Affiliations
Meta-Analysis

Prognostic and clinicopathological value of fibrinogen-to-albumin ratio in patients with esophageal cancer: a meta-analysis

Ye Liu et al. World J Surg Oncol. .

Abstract

Background: Fibrinogen-to-albumin ratio (FAR) has been widely examined for its prognostic value in esophageal cancer (EC), although findings across studies have been inconsistent. This meta-analysis aimed to assess the predictive role of FAR in EC.

Methods: A comprehensive search was conducted across Web of Science, Embase, PubMed, and Cochrane Library. The prognostic value of FAR in EC was assessed by pooling hazard ratios (HRs) and 95% confidence intervals (CIs). Additionally, the correlation between FAR and clinicopathological features of EC was evaluated using pooled odds ratios (ORs) and 95%CIs.

Results: A total of six studies involving 2,616 patients were included. The analysis revealed that a high FAR was significantly associated with poor overall survival (OS) in EC (HR = 1.98, 95%CI = 1.48-2.65, p < 0.001). Furthermore, elevated FAR correlated significantly with male sex (OR = 1.38, 95%CI = 1.09-1.74, p = 0.007), T3-T4 stages (OR = 2.36, 95%CI = 1.93-2.87, p < 0.001), N1-N3 stages (OR = 1.58, 95%CI = 1.32-1.91, p < 0.001), TNM III-IV stages (OR = 2.68, 95%CI = 1.52-4.73, p = 0.001), and tumor length > 3 cm (OR = 2.36, 95%CI = 1.15-4.87, p = 0.020). However, FAR showed no significant association with age (OR = 0.87, 95%CI = 0.48-1.60, p = 0.660), tumor location (OR = 0.98, 95%CI = 0.77-1.25, p = 0.886), or tumor differentiation (OR = 1.09, 95%CI = 0.76-1.56, p = 0.634).

Conclusion: This meta-analysis highlights that an elevated FAR is a strong prognostic indicator of poor OS in patients with EC. Moreover, high FAR is significantly associated with clinical features indicative of tumor progression and metastasis.

Keywords: Biomarker; Esophageal cancer; Evidence-based medicine; Fibrinogen-to-albumin ratio; Meta-analysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare that there is no conflict of interest. Supplemental files: Supplemental file 1 The PRISMA checklist. Supplemental file 2 The detailed search strategies for each database.

Figures

Fig. 1
Fig. 1
PRISMA flowchart for study selection in this meta-analysis
Fig. 2
Fig. 2
Forest plots for the prognostic value of FAR for OS in patients with EC. Increased FAR exhibited close relation to poor OS in EC (HR = 1.98, 95%CI = 1.48–2.65, p < 0.001)
Fig. 3
Fig. 3
Forest plots presenting the association between FAR and clinicopathological features of EC. (A) Gender (male vs. female); (B) Age (years) (≥ 60 vs. < 60); (C) T stage (T3-T4 vs. T1-T2); and (D) Tumor location (middle/lower vs. upper)
Fig. 4
Fig. 4
Forest plots presenting the association between FAR and clinicopathological features of EC. (A) N stage (N1-N3 vs. N0); (B) TNM stage (III-IV vs. I-II); (C) Tumor differentiation (poor vs. well/moderate); and (D) Tumor length (> 3 cm vs. ≤ 3 cm)
Fig. 5
Fig. 5
Sensitivity analysis. Individual studies were removed separately in the sensitivity analysis. The HRs derived from the aggregated results of the remaining studies in each analysis stayed within the anticipated range. Sensitivity analysis revealed reliable study results
Fig. 6
Fig. 6
Publication bias. (A) Begg’s test for OS, p = 0.260; and (B) Egger’s test for OS, p = 0.239. This study analyzed possible publication bias through Begg’s and Egger’s tests. Funnel plots were symmetrical. The results indicated no significant publication bias
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