Abstract
Background: Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression. Herein, we examined the role of fibrinogen-to-albumin ratio index (FARI) in the prognosis of gastrointestinal stromal tumors (GISTs) and developed a novel nomogram predicting recurrence-free survival (RFS).Methods: We retrospectively analyzed data from 357 GIST patients admitted at the gastrointestinal surgery of the Beijing Hospital from January 2008 to January 2018 and underwent curative resection. FARI was calculated as fibrinogen level (g/L) /albumin level (g/L). The cutoff point of FARI was set using the point with the largest Youden index on the receiver operating characteristic curve with the 5-years recurrence-free survival as an endpoint. We used the Kaplan-Meier approach and multivariable Cox regression model to study the impact of FARI on recurrence-free survival. Finally, we developed a nomogram based on tumor size, location, mitotic index, and FARI to predict RFS. The nomogram was assessed by calculating concordance probabilities and testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with the National Institute of Health (NIH) risk classification system.Results: The ROC curve revealed that the best cutoff point of the FARI was set as 0.08. The patients were classified into the FARI-high (≥0.08) and FARI-low (<0.08) groups. FARI was significantly associated with age, size of the tumor, NIH risk category, and Mitotic Index (all P < 0.05). FARI was weakly associated with NLR and PLR. FARI and PNI had a weak negative association. Multivariate analysis showed that the NIH risk category and FARI were independent prognostic predictors for worse outcomes concerning RFS in GIST patients. In the high-risk subgroup, patients with low FARI also had a more prolonged RFS than patients with high FARI (P < 0.05). The nomogram had a concordance probability of 0.802 (SE 0.025). Nomogram predictions were well-calibrated. Concordance probabilities of the nomogram were better than NIH risk classification system [0.802 [0.025] vs. 0.737 [0.024], p < 0.01].Conclusion: We established that preoperative FARI is a novel serum biomarker to predict the prognosis after surgical resection of GISTs. The nomogram incorporating FARI could be used to help the decision-making of clinical treatment.
Highlights
Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression
The most common location of the tumor was the stomach 221(61.9%), the small intestine 75, colon or rectum 27(7.6%), and extra-gastrointestinal stromal tumors 34(E-GIST, 9.5%), including 12 primary tumors located in the mesentery, nine in the retroperitoneum, five in the omentum, three in the liver, two in the prostate, and one in the pancreas, one in the bladder and one in the female reproductive system, respectively
fibrinogen-to-albumin ratio index (FARI) was weakly associated with neutrophil-to-lymphocyte ratio (NLR) (r = 0.236; P < 0.001) and plateletto-lymphocyte ratio (PLR) (r = 0.259, P < 0.001)
Summary
Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression. We examined the role of fibrinogen-to-albumin ratio index (FARI) in the prognosis of gastrointestinal stromal tumors (GISTs) and developed a novel nomogram predicting recurrence-free survival (RFS). Gastrointestinal stromal tumors (GISTs) constitute the most prevalent form of sarcomas in the digestive system. GISTs usually emanate from the interstitial cells of Cajal. The incidence of GISTs in China is 19–22 per million per year [1]. GISTs are neoplasms with different malignant potential ranging from very low risk to high risk. Radical surgery constitutes the first option for resectable GISTs. surgical procedures and targeted adjuvant therapy have markedly improved over the past decade, the long-term prognosis of patients with advanced gastrointestinal stromal tumors remains poor, and the 5-years recurrence rate after an operation is as high as 50% [2]
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