Fibrinogen and Albumin Score Changes during Preoperative Treatment Can Predict Prognosis in Patients with Locally Advanced Rectal Cancer.

Meng-Jun Tang,Wang-Yuan Hu,Shu-Bo Ding

doi:10.1155/2019/3514586

Meng-Jun Tang, Wang-Yuan Hu + Show 1 more

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https://doi.org/10.1155/2019/3514586

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Abstract

Background Fibrinogen (Fib) and albumin (Alb) levels are indicators of systemic inflammatory responses. Elevated Fib and decreased Alb levels are considered negative prognostic factors in different types of cancer. Here, we explored the prognostic value of changes in pre- and post- neoadjuvant chemoradiotherapy (NCRT) plasma fibrinogen and serum albumin (FA) scores in patients with locally advanced rectal cancer (LARC). Methods A total of 106 patients with LARC who underwent NCRT followed by surgical resection at Jinhua Municipal Central Hospital between 2011 and 2015 were analyzed. In addition, plasma Fib and serum Alb levels before and after NCRT were collected. FA scores were calculated based on the Fib and Alb levels dichotomized by clinical reference values. Patients were classified into two groups based on the changes in FA scores during NCRT: in group A, FA scores decreased or remained unchanged (n = 84), and in group B, FA scores increased (n = 22). Changes in FA scores were compared with patient outcomes. Results Increased FA scores were associated with worse disease-free survival (DFS) and overall survival (OS) in patients with LARC. The occurrence of systemic failure was higher in group B than in group A (40.9% vs. 19%, P = 0.032). In multivariate analysis, changes in FA scores, pretreatment carcinoembryonic antigen (CEA) levels, and pathologic differentiation were independent prognostic parameters for DFS and changes in FA scores and pretreatment CEA levels were independent prognostic parameters for OS. Conclusions Increased FA score after NCRT was an independent negative prognostic factor for DFS and OS in patients with NCRT-treated LARC.

Highlights

In 2018, colorectal cancer accounted for over 1.8 million newly diagnosed cases and 881,000 cancer-related deaths globally [1]
The findings of the present study can be summarized as follows: (1) Increased fibrinogen and serum albumin (FA) scores after CRT were associated with high risk of postoperative systemic failure in patients with locally advanced rectal cancer (LARC). (2) Changes in FA scores were an independent prognostic parameter for patients with LARC treated with neoadjuvant chemoradiotherapy (NCRT) and radical surgery
To the best of our knowledge, this is the first study to evaluate the prognostic impact of FA score changes in patients with LARC

Summary

Introduction

In 2018, colorectal cancer accounted for over 1.8 million newly diagnosed cases and 881,000 cancer-related deaths globally [1]. 60% patients with rectal cancer are initially diagnosed with locally advanced tumors with regional and/or distant metastasis. It is imperative to explore promising indicators that can identify locally advanced rectal cancer (LARC) with high risk of recurrence and unfavorable outcome. Fibrinogen (Fib) and Alb are inflammatory markers and are considered useful prognostic parameters in several types of cancer. Fibrinogen (Fib) and albumin (Alb) levels are indicators of systemic inflammatory responses. Elevated Fib and decreased Alb levels are considered negative prognostic factors in different types of cancer. We explored the prognostic value of changes in pre- and post- neoadjuvant chemoradiotherapy (NCRT) plasma fibrinogen and serum albumin (FA) scores in patients with locally advanced rectal cancer (LARC).

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