Aim of the study: Recent evidence has demonstrated that coagulation is associated with tumor progression in various cancers. Fibrinogen, an essential protein in the coagulation cascade and an acute phase element, plays an important role in cancer: different studies have reported that high preoperative fibrinogen level is associated with tumor development and indicates poor prognosis in some malignan- cies. Moreover, it is known that malnutrition is a predictor of progression in several types of cancer and albumin is a commonly used index in clinical practice to assess nutritional status. The aim of the study was to investigate the ability of the albumin to fibrinogen ratio (AFR) to predict survival outcomes in patients affected by muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC). Materials and methods: We retrospectively evaluated data from 122 patients who underwent RC for MIBC at our Institute with a minimum follow-up of 12 months. AFR score was calculated based on the serum albumin concentration and plasma fibrinogen. Patients were classified into two groups: those with low AFR and those with high AFR. Univariate and multivariate analysis were performed. Recurrence-free (RFS) and Overall Survival (OS) rates were calculated and compared between the two groups. To the best of our knowledge no study in literature have combined albumin with fibrinogen in patients with MIBC. Results: Cut-off value to discriminate between low and high AFR score was determined calculating the ROC curve: the area under the curve was 0.78 with an optimal cut-off of 9.53 points. 41(33.6%) patients had low AFR. Distribution of data in low and high AFR groups as mean age at surgery (72.3 ± 8.8 vs 71.1 ± 8.9, p = 0.35), sex (male 23 vs 44 and female 18 vs 37, p = 0.85), presence of high grade disease (39 vs 72, p = 0.33) lymphovascular invasion (LVI) (16 vs 27, p = 0.55), adjuvant chemotherapy (24 vs 58, p = 0.16), mean BMI (25.2 ± 3.9 vs 26.4 ± 4.3, p = 0.17) and urinary diversion were not statistically different between two groups. Pathological features as pT and pN stages were statistically different (0.01 and 0.03 respectively). OS and RFS rates were calculated with a mean follow-up greater in high AFR group (55.2 ± 39.2 vs 37.7 ±34, p = 0.02). Results of the multivariate analysis, after adjustment for age, pT, pN, LVI, surgical margins (R) and ASA score, revealed that AFR was an independent predictor of RFS (HR 4.21, 2.25–7.88; p < 0.001) and OS (HR 1.82, 1.01–3.32, p < 0.001). Discussion: AFR is a potential prognostic predictor of both OS and RFS in patients with MIBC who underwent surgery. Further investigations should be necessary to confirm the good potential of this malnutri- tion-inflammation related tools.
Preoperative impact of albumin to fibrinogen ratio (AFR) on oncological outcomes in patients with muscle invasive bladder cancer treated with radical cystectomy
Claps, F.;Trombetta, C.
2019-01-01
Abstract
Aim of the study: Recent evidence has demonstrated that coagulation is associated with tumor progression in various cancers. Fibrinogen, an essential protein in the coagulation cascade and an acute phase element, plays an important role in cancer: different studies have reported that high preoperative fibrinogen level is associated with tumor development and indicates poor prognosis in some malignan- cies. Moreover, it is known that malnutrition is a predictor of progression in several types of cancer and albumin is a commonly used index in clinical practice to assess nutritional status. The aim of the study was to investigate the ability of the albumin to fibrinogen ratio (AFR) to predict survival outcomes in patients affected by muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC). Materials and methods: We retrospectively evaluated data from 122 patients who underwent RC for MIBC at our Institute with a minimum follow-up of 12 months. AFR score was calculated based on the serum albumin concentration and plasma fibrinogen. Patients were classified into two groups: those with low AFR and those with high AFR. Univariate and multivariate analysis were performed. Recurrence-free (RFS) and Overall Survival (OS) rates were calculated and compared between the two groups. To the best of our knowledge no study in literature have combined albumin with fibrinogen in patients with MIBC. Results: Cut-off value to discriminate between low and high AFR score was determined calculating the ROC curve: the area under the curve was 0.78 with an optimal cut-off of 9.53 points. 41(33.6%) patients had low AFR. Distribution of data in low and high AFR groups as mean age at surgery (72.3 ± 8.8 vs 71.1 ± 8.9, p = 0.35), sex (male 23 vs 44 and female 18 vs 37, p = 0.85), presence of high grade disease (39 vs 72, p = 0.33) lymphovascular invasion (LVI) (16 vs 27, p = 0.55), adjuvant chemotherapy (24 vs 58, p = 0.16), mean BMI (25.2 ± 3.9 vs 26.4 ± 4.3, p = 0.17) and urinary diversion were not statistically different between two groups. Pathological features as pT and pN stages were statistically different (0.01 and 0.03 respectively). OS and RFS rates were calculated with a mean follow-up greater in high AFR group (55.2 ± 39.2 vs 37.7 ±34, p = 0.02). Results of the multivariate analysis, after adjustment for age, pT, pN, LVI, surgical margins (R) and ASA score, revealed that AFR was an independent predictor of RFS (HR 4.21, 2.25–7.88; p < 0.001) and OS (HR 1.82, 1.01–3.32, p < 0.001). Discussion: AFR is a potential prognostic predictor of both OS and RFS in patients with MIBC who underwent surgery. Further investigations should be necessary to confirm the good potential of this malnutri- tion-inflammation related tools.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
