| Objective Nutritional status and inflammation are closely related to the occurrence and long-term survival of malignant tumors.The level of human serum albumin can not only reflect the nutritional level of the body,but also indicate the presence of inflammation.Fibrinogen is not only involved in the coagulation reaction of human body,but also an acute protein in inflammatory response.In this study,a meta-analysis was performed to investigate the effect of albumin to fibrinogen ratio(AFR)on the prognosis of colorectal cancer patients.And the clinical data of 152 CRC patients were retrospectively analyzed to verify the predictive efficacy of AFR in the assessment of prognosis of CRC patients before treatment.Methods Pubmed,Wanfang,Cnki and VIP were searched in this study.Search deadline is March 14,2020.Literature quality was evaluated by measurements as described in a previous literature.After data extraction,meta-analysis was performed with Stata 12.0 software.HR and 95%Confidence Interval(CI)were used to evaluate the prognostic value of plasma AFR before treatment in patients with colorectal cancer.Heterogeneity was assessed by Q test,I~2 and sensitivity analysis.At the same time,the prognostic efficacy of AFR in CRC was verified.The clinicopathological and laboratory data of 152 patients with colorectal cancer diagnosed and treated from March 2014 to December 2014 were retrospectively analyzed,and the survival conditions of the patients were followed up by telephone.The optimal cut-off value of AFR was determined by x-tile 3.6.1 software(Yale University,New Haven,CT,USA).By use of SPSS20.0 software,the relationship between AFR and clinicopathological parameters of patients with colorectal cancer was assessed with T test and Chi-square analysis.In order to assess the prognosis prediction efficiency of clinical data and laboratory indexes in CRC patients,the survival analysis was performed with Kaplan Meier method,Log-rank test,combined with the application of COX proportional hazards regression model.Results In the META part,4 articles(1732 cases)were included in this study.One of the articles was divided into two subgroups according to different treatment methods,and the survival analysis data of the two groups was finally calculated.Among the 5 groups of survival analysis data in 4 literatures,5groups of survival analysis data were divided into 4 subgroups according to different survival indexes:OS(U)+OS(M)+PFS group,OS(M)group,OS(U)group,and PFS group.The combined HR results of each group were as follows:1.68(95%CI=1.42-1.98,P<0.001),1.54(95%CI=1.18-2.03,P=0.002),1.75(95%CI=1.49-2.05,P<0.001),1.75(95%CI=1.36-2.27,P<0.001).Heterogeneity detection indicated that there was no significant heterogeneity in the combined results of 4 studies.Validation analysis of the prognostic efficacy of AFR:in this study,152eligible CRC patients were enrolled,including 94 males and 58 females,with an average age of 57±12 years.Of the 152 patients,26(17.11%)were lost to follow-up,while 51 died and 75 survived.The median survival time was66(34,68)months.Preliminary statistics showed that there were significant differences of AFR levels in lymph node metastasis,distant metastasis,tumor stage,differentiation degree and tumor location before treatment(P<0.05).The optimal cut-off value of AFR was 6.2.After grouping according to the optimal cut-off value,it was found that the 5-year survival rate of patients in the high-level and low-level AFR groups before treatment was 61.5%and 40.9%,respectively,with no significant difference(X~2=3.833,P=0.050).Subsequently,the results of log-rank test by Kaplan Meier method showed that OS in the low AFR group was significantly lower than that in the high AFR group(P=0.038).Univariate COX survival regression analysis showed that low AFR was significantly correlated with poor OS(HR=1.384,P=0.042).However,with multivariate COX analysis,there was no clear correlation between low AFR and poor OS(HR=1.297,P=0.441).The“current HR”obtained by this part of multivariate COX analysis was combined with HRs in the part of META analysis[“OS(U)+OS(M)+PFS”cochort],and the results of the combined HR was 1.65(P<0.001).Conclusion The results of this study showed that AFR was associated with lymph node metastasis,distant metastasis,TNM stage,tumor differentiation degree and the position of colorectal cancer.Low AFR predicted poor prognosis of colorectal cancer before treatment,which may be an effective potential indicator for evaluating prognosis of colorectal cancer patients. |
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