Abstract
BackgroundSystemic inflammation and nutritional status are associated with tumor development and progression. This study investigated the prognostic value of fibrinogen/albumin ratio index (FARI) in predicting recurrence-free survival (RFS) in patients with intrahepatic cholangiocarcinoma (ICC) undergoing hepatectomy.MethodsA retrospective cohort was conducted including patients who received curative hepatectomy for ICC at our hospital between May 2010 and December 2016. We collected the preoperative hematologic parameters and clinical data of all patients. Time-dependent receiver operating characteristic curve was used to identify the optimal cutoff value of FARI. The association between FARI-high and FARI-low group was investigated by using the Kaplan–Meier method. A nomogram based on the results of univariate and multivariate analysis was established.ResultsA total of 394 patients with ICC who underwent hepatectomy at our hospital were enrolled. K-M analysis revealed that increased FARI was related to reduced RFS (P < 0.001). The multivariate analysis indicated that tumor number, tumor–node–metastasis stage, lymph node metastasis, cirrhosis, serum carbohydrate antigen 19-9, and FARI were independent predictors of RFS, and the ROC curve analysis showed that the optimal cutoff value for FARI was 0.084 based on the Youden index. The nomogram for FARI showed satisfactory accuracy in predicting RFS for ICC patients undergoing hepatectomy (C index = 0.663; AIC = 3081.07).ConclusionPreoperative FARI is an independent predictor of RFS in patients undergoing hepatectomy for ICC, and the nomogram can be useful for clinical decision-making in the postoperative management of these patients.
Highlights
Hepatocellular carcinoma and intrahepatic cholangiocarcinoma account for ~ 85% of primary liver tumors
We evaluated the prognostic value of fibrinogen/albumin ratio index (FARI) in these patients and established a nomogram for predicting recurrence-free survival (RFS) based on this index
We found that a high FARI was correlated with inflammatory indicators including high neutrophil-to-lymphocyte ratio (NLR) and glutamyltransferase-to-lymphocyte ratio (GLR) and low alkaline phosphatase (ALP) ratio (AAPR)
Summary
Hepatocellular carcinoma and intrahepatic cholangiocarcinoma account for ~ 85% of primary liver tumors. Intrahepatic cholangiocarcinoma (ICC), which originates in second-order bile ducts, accounts for 10–15% of hepatobiliary malignancies [1]. The 5-year overall survival for ICC is ~ 20%; this low rate may be attributable to the aggressivity and heterogeneity of the tumors [4]. Surgery is considered the most effective treatment but only about 20% of patients undergo potentially curative resection [5]. Chemotherapy is the standard of care for patients with unresectable ICC [6, 7], while immunotherapy has recently shown favorable results, suggesting new possibilities in the treatment of ICC [8]. This study investigated the prognostic value of fibrinogen/albumin ratio index (FARI) in predicting recurrence-free survival (RFS) in patients with intrahepatic cholangiocarcinoma (ICC) undergoing hepatectomy
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