| BackgroundGallbladder carcinoma is the most common tumor of the biliary tract system,accounting for 80%-95%of the incidence.There are significant geographical and ethnic differences in the whole world.The incidence is extremely high in American Indians,followed by Southeast Asia,but the incidence is low in the Americas and other parts of the world[1].Because of its hidden disease,early onset often do not have any symptoms,most symptoms only characterized by nausea,poor appetite,abdominal distension,abdominal pain,vomiting,right upper abdominal dull pain and other symptoms,because the symptom is not obvious,vulnerable to the patient’s neglected,has missed the best period of treatment with the development of the disease,abdominal pain symptoms gradually apparent,to the hospital,More has reached in late,therefore,the prognosis is poor.Which are the major factors affecting the prognosis of gallbladder lymph node metastasis,tumor differentiation degree,infiltration depth and the principle of TNM staging,pathological diagnosis index,in clinical work,also often appear in installment the prognosis of patients with the same are significantly different,at present,in view of the various treatments in the gallbladder,surgery is still the most effective radical excision,However,only 10%of patients can be treated with R0 resection.Even if patients are treated with radical surgery,the 5-year survival rate is only 16%-1 8%.Moreover,various adjuvant therapies for gallbladder cancer after surgery,such as radiotherapy,chemotherapy and targeted therapy,have limited effect on improving the prognosis.It is particularly important to comprehensively evaluate the condition of patients with gallbladder cancer according to the preoperative examination results,which can not only provide a basis for the formulation of individualized treatment plans,but also more accurately predict the prognosis of patients.TNM staging system has become one of the most commonly used indicators to predict the prognosis of various malignant tumors.However,TNM staging is often performed after tumor resection and depends on reliable pathological diagnosis.Therefore,there is a need to develop new readily available biomarkers to accurately predict prognosis.In recent years,studies have reported that the preoperative Fibrinogen to albumin ratio(FAR)has important clinical value in evaluating the prognosis of malignant tumors.Moreover,FAR,as a marker for evaluating the prognosis of malignant tumors,has been proved to be prognostic in gastric cancer,liver cancer,kidney cancer,breast cancer and other malignant tumors[2-4].ObjectiveThe purpose of this study was to evaluate the clinical value of preoperative FAR in predicting the prognosis of patients with gallbladder cancer,and to explore the clinicopathological characteristics of patients with gallbladder cancer at different FAR levels,as well as the relationship between other known prognostic risk factors of gallbladder cancer.MethodsThe clinical data of 92 patients with gallbladder cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2017 were retrospectively collected.The optimal bound value of FAR is determined by Receiver operating characteristic curve(ROC)of the tested worker.The measurement data conforming to the normal distribution was expressed as x±s,and the measurement data not conforming to the normal distribution was expressed as the median.The qualitative data were compared with the distribution of variables using the chi-square test or Fisher’s exact test.Kaplan-Meier method was used for survival analysis,and log-rank test was used for survival comparison.The factors related to prognosis were included in Cox proportional risk regression model for univariate and multivariate analysis,and the independent risk factors affecting prognosis were finally screened out.P<0.05 was considered statistically significant.ResultsThe preoperative FAR was taken as the test variable,and the ROC Curve analysis of FAR showed that the Area Under Curve(AUC)was 0.679.When the Youden index was the maximum,the corresponding FAR bound value was 0.09,the corresponding sensitivity was 59.3%,and the specificity was 76.3%.Taking 0.09 as the boundary value,the patients were divided into low FAR group and high FAR group.The clinicopathological data of the two groups were analyzed and compared,and it was found that it was correlated with gender and the concentration of Carbohydrate antigen 19-9(CA19-9).The average FAR level of male patients was higher than that of female patients.In the low FAR group,20 cases(40%)had CA19-9>37ng/ml,while in the high FAR group,28 cases(66.7%)had CA19-9>37ng/ml.The 1-,2and 3-year survival rates of 92 patients with gallbladder carcinoma were 48.9%,38.6%and 29.1%,and the overall median survival time was 12 months(95%CI:6.9 to 17.1 months).Taking 0.09 as the threshold,gallbladder carcinoma patients were divided into two groups:FAR≤0.09 and>0.09.Compared with the survival curves of the two groups,the prognosis and survival of patients in the low FAR group was significantly better than that in the high FAR group.The postoperative 1-,2-and 3-year survival rates in the low FAR group were 67.0%,52.9%and 41.1%,and the median survival time was 15 months(95%CI:12.8-20.8 months).The postoperative 1-,2-and 3-year survival rates of the high FAR group were 26.4%,15.4%and 15.4%,and the median survival time was 6 months(95%CI:6.6-12.2 months).All patients died of tumor recurrence,and the difference in median survival time between the two groups was statistically significant(P<0.05).Based on clinicopathological data and survival analysis,tumor differentiation degree,invasion depth,lymphatic metastasis,liver invasion,CA19-9,Carcinoembryonic antigen(CEA),and FAR were associated with prognosis and survival of gallbladder carcinoma(all P<0.05).Univariate and multivariate analyses showed that the degree of tumor differentiation,CA19-9,lymphatic metastasis,liver invasion,TNM stage and FAR were independent risk factors affecting the prognosis of patients with gallbladder carcinoma.ConclusionsFAR has certain clinical value in predicting the prognosis of gallbladder cancer.A high preoperative level of FAR is associated with a shorter postoperative overall survival,indicating a higher inflammatory index and a worse prognosis.It is a clinically inexpensive,simple and easily available prognostic index.It can be used as an indicator to evaluate the prognosis of gallbladder carcinoma. |
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