To Explore The Role Of The Ratio Of Preoperative Fibrinogen To Prealbumin In The Prognosis Of Clear Cell Renal Cell Carcinoma Based On The Decision Curve Analysis

Objective: To explore the value of preoperative fibrinogen to prealbumin ratio(FPR)in the prognosis of patients with clear cell renal cell carcinoma(cc RCC),and compare its ability to predict prognosis with traditional inflammatory factors,and establish a new Prognostic model.Methods: This study included 204 cc RCC patients who underwent radical nephrectomy or partial nephrectomy from 2012 to 2016,and a retrospective analysis was performed.Use receiver operating characteristic(ROC)curve to determine the best cut-off value of FPR in peripheral blood,divide FPR into high(49 cases)and low(155 cases)two groups,and compare the overall survival rate of the two groups And analyze the prognostic risk factors.The nomogram constructed by independent factors is used to predict the survival outcome of cc RCC patients after surgery.The C index and the decision curve analysis(DCA)are used to evaluate the predictive performance of related factors and models.Results: The FPR value of advanced tumors was significantly higher than that of the early tumor group.FPR and age(P=0.025),tumor size(P=0.002),hemoglobin(HGB)(P<0.001),endogenous creatinine clearance(Ccr)(P=0.003),prealbumin(P<0.001),symptom(P=0.004),surgery(P<0.001),tumor necrosis(P<0.001),and the tumor-node-matastasis(TNM)stage(P<0.001)are closely related.Cox univariate analysis showed that the factors affecting OS were age(P=0.011),hemoglobin(P=0.043),endogenous creatinine clearance(P=0.001),symptom(P=0.013),and surgery(P=0.002),tumor size(P<0.001),tumor necrosis(P=0.029),TNM stage(P<0.001),Fuhrman grade(P=0.004),FPR(P<0.001),prealbumin(P<0.001),fibrinogen(P<0.001),platelet-to-lymphocyteratio(PLR)(P<0.001),neutrophil-to-lymphocyte ratio(NLR)(P<0.001)and systemic immune-inflammation index(SII)(P<0.001).Cox multivariate regression analysis showed that the independent prognostic factors affecting the survival rate of cc RCC patients were FPR(HR=2.583,95%CI=1.082-6.164,P=0.033),PLR(HR=2.785,95% CI=1.222-6.345,P =0.015)and TNM stage(HR=4.044,95% CI=1.813–9.021,P=0.001).The C index and DCA for predicting prognosis of FPR are better than traditional inflammatory factors,and the nomogram composed of multiple factors has better predictive ability for patients after cc RCC.Conclusion: 1.High FPR in peripheral blood is an independent risk factor for poor prognosis of cc RCC patients;2.The nomogram constructed by FPR,PLR and TNM staging has a certain predictive value for the prognosis of cc RCC patients,and makes the patient’s net benefit the highest;3.Compared with traditional inflammatory biomarkers such as PLR,NLR,SII,FPR has obvious advantages;4.The combined application of fibrinogen and prealbumin has a better prognostic evaluation effect than the application of fibrinogen or prealbumin alone.