Relationship Between Fibrinogen to Albumin Ratio and Prognosis of Gastrointestinal Stromal Tumors: A Retrospective Cohort Study

Objective: The fibrinogen to albumin ratio (FAR) is an important parameter that reflects the coagulation state, systemic inflammation, and nutritional status of a patient and plays an essential role in tumor progression. Here, we evaluate the prognostic significance of FAR in gastrointestinal stromal tumor (GIST) patients that underwent radical surgery.

Methods: We retrospectively analyzed the data of 227 GIST patients that underwent radical surgery in Beijing Hospital from October 2004 to July 2018. We drew a curve of receiver operating characteristics to confirm the optimal critical values for hemoglobin (Hb), prognostic nutrition index (PNI), and FAR. Cox regression analysis and the Kaplan-Meier method were used to assess the prognostic factors.

Results: The FAR optimal critical value for postoperative recurrence-free survival (RFS) was 0.09. Many significant factors, including approach, the location and size of the tumor, mitotic index, risk classification, Hb levels, PNI, and recurrence, affect FAR. Multivariate analysis indicated that for patients with GISTs who underwent surgery, the tumor location (hazard ratio [HR]=3.393, 95% confidence interval [CI]: 1.539-7.479, P=0.002), mitotic index (HR=4.788, 95% CI: 1.836-12.486, P=0.001), tumor rupture (HR=10.954, 95% CI: 2.170-55.296, P=0.004), and FAR (HR=3.093, 95% CI: 1.303-7.339, P=0.010) were independent factors affecting RFS. Moreover, the FAR remained of prognostic significance for GIST stratified by subgroup analysis.

Conclusion: Preoperative FAR is a reliable marker for evaluating the prognosis of GIST, the prognostic ability of FAR is significantly better than Hb and PNI.

Keywords: fibrinogen to albumin ratio; gastrointestinal stromal tumors; hemoglobin; prognosis; prognostic nutrition index.