The Diagnostic And Predictive Value Of Fibrinogen To Pre-Albumin Ratio In Colorectal Cancer

BackgroundIn recent years,the important roles of inflammation in tumor onset and development have aroused great interest in medical research.Multiple evidence reveal that inflammation could promote tumorigenesis and progression by regulating inflammatory mediators,immune system and affecting angiogenesis in the tumor microenvironment.Hence,the investigation of diagnostic and predictive value of inflammation-based biomarker in cancer seems to be meaningful.Colorectal cancer(CRC)is one of the most common malignancies worldwide,which is mainly treated by surgical operation.Early diagnosis ensure that patients undergo surgical treatment as soon as possible and postoperative evaluation could monitor the tumor progression.Therefore,it's urgent to find stable,economic and feasible biomarker to increase diagnosis efficacy and predict the prognosis of CRC patients.Until now,some novel biomarkers which reflected the systemic inflammation have been increasingly investigated in the prediction of cancer progression and prognosis,such as neutrophil-to-lymphocyte ratio(NLR)and the Glasgow prognostic score(GPS).However,little related research with regard to Fibrinogen(Fib)or pre-Albumin(pAlb)has been done.ObjectiveTo investigate the diagnostic and predictive value of a novel inflammatory biomarker—Fibrinogen to pre-Albumin ratio(FPR)for CRC patients.MethodsThe study was divided into two sections which consist of the adjuvant diagnosis and predictive efficacy using FPR.In the diagnosis portion,455 CRC patients newly diagnosed at the Second Affiliated Hospital of Nanchang University between January 2011 and December 2013 were enrolled.Meanwhile,455 patients with colorectal polyp were included as benign controls,and sex and age matched healthy individuals were enrolled as healthy controls.We firstly explored the diagnosis value of FPR in CRC,and then investigate the efficacy of FPR in distinguishing CRC from benign colorectal disease.In the prognosis portion,a total of 555 I-III stage resected CRC patients diagnosed in the Second Affiliated Hospital of Nanchang University and the first hospital of Nanjing between January 2011 and December 2013 were enrolled.The optimal cut-off points and prognostic values of FPR were assessed by X-tile software,Kaplan-Meier curve and Cox regression model.The CRC prognostic nomogram was established and it predictive efficacy was determined by Harrell's concordance index(C-index).ResultsOn one hand,the optimal cut-off value of FPR in the diagnosis for CRC patients was 15.36 and the Area under curve(AUC)was 0.738.Better yet,the AUC of FPR in telling CRC apart from benign disease was 0.801 and the cut-off value was 12.274(sensitivity,Sen=72.7%,specificity,Spe=74.3%,positive predictive value,PPV=73.9%,negative predictive value,NPV=73.2%).Moreover,the combination of FPR,CEA and CA199 had the optimal efficiency in distinguishing CRC from benign disease(AUC=0.845,Sen=67.9%,Spe=85.3%,PPV= 83.5%,NPV=70.9%).On the other hand,we found that preoperative FPR was correlated with clinical pathological parameters of CRC patients closely.And the optimal cut-off value of preoperative FPR was 18.3 in the predictive analysis.Our results showed that high FPR level was obviously associated with poor survival of CRC.Circulating high levels of FPR(crude Hazard ratio,HR=2.398,95% confidence interval,95%CI=1.567-3.669;adjusted HR=1.940,95%CI=1.236-3.046)were significantly correlated with high risk of death of patients with CRC.The c-index of nomogram containing FPR was significantly higher than that without FPR(p<0.05).ConclusionFPR represent a novel,practical and economical CRC diagnostic biomarker,and the combination of FPR,CEA and CA199 could greatly improve the diagnostic efficacy in discriminating CRC from benign colorectal disease.Furthermore,our findings indicated that preoperative FPR was a biomarker to assess the progression and cancer burden of CRC.