An Bang, Liu Tong, Li Xiao
Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan 250013, Shandong Province, China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
J Cancer. 2024 Sep 23;15(18):5968-5977. doi: 10.7150/jca.100674. eCollection 2024.
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. 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. 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). 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.
有限的研究阐明了术前纤维蛋白原和白蛋白（FA）评分在结直肠癌（CRC）中的作用。我们旨在明确FA评分对接受根治性切除的CRC患者预后和化疗疗效的预测价值。回顾性纳入了735例接受CRC切除患者的临床病理参数。通过受试者工作特征（ROC）曲线确定术前血浆纤维蛋白原（F）和白蛋白（A）的最佳截断值。根据FA评分将患者分为三组，并进一步分为化疗组和非化疗组。采用Kaplan-Meier（KM）生存法、单因素和多因素Cox比例风险模型以及亚组分析评估FA评分与临床病理特征、总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS）之间的相关性。Kaplan-Meier生存曲线显示，较高的FA评分可预测较差的OS和CSS（P<0.001）。多因素分析显示，FA评分是OS的独立预后因素（P=0.037）。此外，基于组织学特征和原发肿瘤部位的亚组分析表明，在非黏液性结直肠腺癌和直肠癌（RECC）患者中，FA评分升高与较差的OS、CSS和DFS显著相关（均P<0.05）。基于TNM分期的亚组分析表明，在TNM II期肿瘤患者中，FA评分升高与较差的OS、CSS显著相关（均P<0.05）。此外，化疗可使FA评分为1和2的TNM III期CRC患者的OS和CSS受益（均P<0.05）。术前FA评分是接受根治性切除的CRC患者的独立预后因素，可能有助于在临床实践中预测对化疗的反应。FA评分可作为TNM分期系统的补充，以识别高危患者。
