Prognostic value of a novel FPR biomarker in patients with surgical stage II and III gastric cancer
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Jing Zhang1,*, Shu-Qi Li1,*, Zhi-Hua Liao2,*, Yu-Huan Jiang1, Qing-Gen Chen1, Bo Huang1, Jing Liu1, Yan-Mei Xu1, Jin Lin1, Hou-Qun Ying1 and Xiao-Zhong Wang1
1Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
2Department of Clinical Laboratory, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, 330006, China
*Authors contributed equally to this work
Xiao-Zhong Wang, email: [email protected]
Hou-Qun Ying, email: [email protected]
Keywords: inflammation, gastric cancer, prognosis, nomogram
Received: March 07, 2017 Accepted: July 25, 2017 Published: September 06, 2017
Background: Inflammation and nutrition are two main causes contributing to progression of gastric cancer (GC), and inflammatory biomarker may be presented as its valuable prognostic factor. Thus, this study was carried out to investigate the prognostic significance of preoperative circulating albumin/fibrinogen ratio (AFR), fibrinogen/pre-Albumin ratio (FPR), fibrinogen (Fib), albumin (Alb) and pre-Albumin (pAlb) in surgical GC.
Materials and Methods: Three hundred and sixty surgical stage II and III GC patients from June 2011 to December 2013 were enrolled in this retrospective study. X-tile software, Kaplan–Meier curve and Cox regression model were used to evaluate the prognostic role of them. A predictive nomogram was established to predict prognosis of overall survival (OS), and its accuracy was assessed by concordance index (c-index).
Results: Decreased Alb, pAlb, AFR and elevated FPR were significantly associated with shorter OS. FPR was identified as the most effective prognostic factor to predict 3-year’s OS by time-dependent ROC analysis. A long survival was observed in patients with low level of FPR and the prognosis of stage III FPR-low GC patients undergoing chemotherapy was significantly superior to the patients without the treatment (P=0.002). However, no difference of survival was examined in stage II subgroups stratified by FPR and high FRP of stage III patients with or not the treatment of chemotherapy. C-index of nomogram containing FPR (c-index=0.756) was high in comparison with the nomogram without FPR (c-index =0.748).
Conclusion: Preoperative FPR might be a feasible prognostic biomarker in surgical stage II and III GC and it could precisely distinguish stage III patients who appeared to obviously benefit from adjuvant chemotherapy. Meanwhile established nomogram based on clinical parameters and FPR could improve its predictive efficacy.
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