Cancer Res Treat.  2021 Jan;53(1):131-139. 10.4143/crt.2020.330.

Systemic Inflammatory Biomarkers, Especially Fibrinogen to Albumin Ratio, Predict Prognosis in Patients with Pancreatic Cancer

• Fang L
• Yan FH
• Liu C
• Chen J
• Wang D
• Zhang CH
• Lou CJ
• Lian J
• Yao Y
• Wang BJ
• Li RY
• Han SL
• Bai YB
• Yang JN
• Li ZW
• Zhang YQ

• KMID: 2510655
• DOI: http://doi.org/10.4143/crt.2020.330

Abstract

Purpose
Systemic inflammatory response is a critical factor that promotes the initiation and metastasis of malignancies including pancreatic cancer (PC). This study was designed to determine and compare the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and fibrinogen-to-albumin ratio (FAR) in resectable PC and locally advanced or metastatic PC.
Materials and Methods
Three hundred fifty-three patients with resectable PC and 807 patients with locally advan-ced or metastatic PC were recruited in this study. These patients were classified into a training set (n=758) and a validation set (n=402). Kaplan-Meier survival plots and Cox proportional hazards regression models were used to analyze prognosis.
Results
Overall survival (OS) was significantly better for patients with resectable PC with low preoperative PLR (p=0.048) and MLR (p=0.027). Low FAR, MLR, NLR (p < 0.001), and PLR (p=0.003) were significantly associated with decreased risk of death for locally advanced or metastatic PC patients. FAR (hazard ratio [HR], 1.522; 95% confidential interval [CI], 1.261 to 1.837; p < 0.001) and MLR (HR, 1.248; 95% CI, 1.017 to 1.532; p=0.034) were independent prognostic factors for locally advanced or metastatic PC.
Conclusion
The prognostic roles of FAR, MLR, NLR, and PLR in resectable PC and locally advanced or metastatic PC were different. FAR showed the most prognostic power in locally advanced or metastatic PC. Low FAR was positively correlated with OS in locally advanced or metastatic PC, which could be used to predict the prognosis.

Keyword

Pancreatic neoplasms; Systemic inflammatory markers; Fibrinogen-to-albumin ratio; Prognosis; Survival

Figure

• 

  Fig. 1 Kaplan-Meier survival curves of resectable pancreatic cancer (PC) patients in training set based on platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR). (A) Data in training set compares PLR ≤ 139.63 vs. > 139.63 (p < 0.05). (B) Data in training set compares MLR ≤ 0.45 vs. > 0.45 (p < 0.05).

• 

  Fig. 2 Kaplan-Meier survival curves of locally advanced or metastatic pancreatic cancer (PC) patients in training set based on fibrinogen-to-albumin ratio (FAR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). (A) Data in training set compares FAR ≤ 0.079 vs. > 0.079 (p < 0.001). (B) Data in training set compares MLR ≤ 0.36 vs. > 0.36 (p < 0.001). (C) Data in training set compares NLR ≤ 2.61 vs. > 2.61 (p < 0.001). (D) Data in training set compares PLR ≤ 170.73 vs. > 170.73 (p < 0.05).

• 

  Fig. 3 Receiver operating characteristic (ROC) analysis based on fibrinogen-to-albumin ratio (FAR) (B), monocyte-to-lymphocyte ratio (MLR) (C), neutrophil-to-lymphocyte ratio (NLR) (D), platelet-to-lymphocyte ratio (PLR) (E) of locally advanced or metastatic pancreatic cancer patients in training set. (A) The area under the ROC curve (AUC) indicates the diagnostic power of FAR was the most powerful. (B) The AUC indicates the diagnostic power of FAR. In this model, the best cut-off point for FAR was 0.079, AUC was 0.641 (95% confidence interval [CI], 0.594 to 0.689), the sensitivity of the Yoden index was 0.635, and the specificity was 0.656. (C) The AUC indicates the diagnostic power of MLR. In this model, the optimal cut-off point for MLR was 0.36, AUC was 0.569 (95% CI, 0.519 to 0.619), the sensitivity of the Yoden index was 0.635, and the specificity was 0.504. (D) The AUC indicates the diagnostic power of NLR. In this model, the optimal cut-off point for NLR was 2.61, AUC was 0.558 (95% CI, 0.507 to 0.609), the sensitivity of the Yoden index was 0.416, and the specificity was 0.721. (E) The AUC indicates the diagnostic power of PLR. In this model, the best cut-off point for PLR was 170.73, AUC was 0.548 (95% CI, 0.498 to 0.598), the sensitivity of the Yoden index was 0.761, and the specificity was 0.341.

Reference

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