| Background and purposeGastric cancer is one of the most common malignant tumors in the world.Radical gastrectomy is a commonly used treatment method of gastric cancer patients,but there is still a high rate of local or distant recurrence and metastasis after that,which is the main cause of postoperative death of patients.Therefore,it is particularly important to study the risk factors affecting gastric cancer recurrence and metastasis.This study investigated the correlation between preoperative fibrinogen to albumin ratio(FAR)and postoperative recurrence and metastasis in patients with gastric cancer.Materials and methodsClinical data,pathological data,preoperative blood routine,fibrinogen,albumin and other indicators of patients with gastric cancer diagnosed by pathology after radical gastrectomy in the Second Affiliated Hospital of Zhengzhou University from January 2014 to January 2017 were collected,and a total of 170 patients were included.A total of 150 cases were included in the control group of healthy physical examinees from our physical examination center at the same time.We used SPSS 23.0 software to analyze the statistics.The independent sample t test was used to compare the values of fibrinogen,albumin,FAR,neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)between gastric cancer group and control group.The X-tile software was used to determine the best cut off values of FAR,NLR and PLR.According to best cut off value,the case data of gastric cancer was divided into high FAR group and low FAR group.The ?2 test was used to analyze the relationships between FAR and clinicopathological characteristics.We used Pearson correlation analysis and Spearman rank correlation analysis to evaluate the correlation between FAR and inflammatory indicators and pathological stages.Kaplan-Meier curve was used to estimate the disease-free survival rate(DFS)of each group,and log-rank test was applied to compare the differences of survival curves of each group.Univariate and multivariate Cox proportional risk regression models were used to evaluate the factors affecting gastric cancer recurrence and metastasis.Receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the predictive efficacy of FAR in patients with gastric cancer.Results1.There was no statistically significant difference in age and gender between the gastric cancer group and the healthy control group(P>0.05).The indicators of fibrinogen,FAR,NLR and PLR in the gastric cancer group were significantly higher than those in the control group,the albumin of gastric cancer group was lower than control group,and the difference was statistically significant(P<0.05).2.According to the X-tile software,the optimal thresholds for predicting DFS of FAR,NLR and PLR were calculated to be 9.3,2.9 and 158.4,respectively.Gastric cancer patients were divided into two groups according to the critical value,namely,the high FAR group(FAR?9.3,n=67)and the low FAR group(FAR<9.3,n=103).There was higher proportion of patients with tumor diameter>5cm,vascular and nerve invasion in high FAR group than low FAR group(62.7%vs 43.7%,74.6%vs 44.7%,50.7%vs 29.9%).High FAR group had deeper infiltrating depth(T3-T473.1%vs 55.3%),later lymph node staging(N1-N3 85.1%vs 70.9%),later TNM staging(? stage 52.2%vs 34%).There was no significant difference between the two groups in terms of age,sex,tumor site and differentiation degree(P>0.05).3.The results of Pearson correlation analysis revealed that FAR was significantly positively correlated with NLR(r=0.494,P<0.001)and PLR(r=0.418,P<0.001).Spearman rank correlation analysis showed that FAR was positively correlated with infiltration depth(rs=0.270,P=0.030)and TNM stage(rs=0.298,P=0.016),while FAR was not significantly correlated with lymph node metastasis(rs=0.180,P=0.151).4.The disease-free survival rate(DFS)of the high FAR group was significantly lower than that of the low FAR group(log-rank test,P<0.001).Hierarchical analysis showed that there was no significant difference of period I patients between two groups(log-rank test P=0.052),in patients with stage ? and ?,high FAR had lower DFS significantly than the low FAR group(? stage,log-rank test P=0.003,? stage log-rank test P=0.001).5.Single factor analysis revealed that tumor size,vascular invasion,nerve invasion,invasion depth,lymph node stage,TNM stage,FAR,NLR and PLR were related to DFS.Meaningful indexes were analyzed by the multiple-factor analysis and the result showed that the tumor? 5 cm(HR=2.680,95%CI:1.059-6.784,P=0.037),vascular invasion(HR=2.277,95%CI:1.193-4.347,P=0.013),TNM stage for?(HR=2.080,95%CI:1.188-3.641,P=0.010)and FAR?9.3(HR=2.639,95%CI:1.282-5.432,P=0.008)were the risk factor for postoperative recurrence and metastasis.Conclusion1.FAR is related to the clinicopathological characteristics of gastric cancer patients.The patients of higher FAR had a larger tumor diameter,a higher proportion of patients with vascular and nerve invasion,deeper infiltration,and later lymph node staging and TNM staging.2.FAR is an independent factor affecting DFS of postoperative gastric cancer patients,and FAR is related to the recurrence and metastasis of postoperative gastric cancer patients. |
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