| Objective:To investigate the prognostic value of preoperative fibrinogen to pre-albumin ratio(FPR)in patients with Gallbladder cancer(GBC)after radical surgery and explore a new effective marker for predicting the prognosis of gallbladder cancer after radical operation.Methods:Patients who underwent gallbladder cancer radical operation in The Second Affiliated Hospital of Kunming Medical University from November 1,2013to June 30,2022 and were pathologically diagnosed as gallbladder cancer after surgery were retrospectively collected.A total of 112 patients were selected as subjects by inclusion criteria and exclusion criteria.The optimal cut-off values of FPR,NLR,CA19-9,CA125,CEA,age and BMI were calculated using the receiver operating characteristic curve.Kaplan-Meier survival curve was used to analyze the correlation between preoperative FPR,NLR,CA19-9,CA125,CEA,age,sex,BMI,gallstone,preoperative jaundice,surgical method(open surgery/laparoscopic surgery),expanded radical resection,tumor site,maximum tumor diameter,pathological type,histological grading,T stage,N stage,distant metastasis,TNM stage,liver invasion,perineural invasion,postoperative adjuvant chemotherapy and Overall survival(OS)after gallbladder cancer radical resection.COX univariate and multivariate regression analysis was used to determine the prognostic factors of patients with gallbladder cancer after radical surgery.Finally,R software was used to establish a nomogram model and evaluate it by concordance index and calibration curve.Results:The optimal cut-off values for FPR,NLR,CA19-9,CA125,CEA,age and BMI are 13.57,2.77,81.51 KU/ml,29.22 KU/ml,3.77 ng/ml,50.50 years old and20.64 kg/m~2,respectively.COX univariate analysis shows that:expanded radical resection(HR=2.366,p=0.001),histological grade G3-G4(HR=2.680,p<0.001),tumor site in the cystic duct or neck(HR=1.723,p=0.032),maximum tumor diameter>2.3cm(HR=1.981,p=0.013),T3-4 stage(HR=8.429,p=0.003),high N stage[N1 stage(HR=4.128,p<0.001),N2 stage(HR=8.639,p<0.001)],distant metastasis(HR=2.740,p=0.008),liver invasion(HR=5.379,p<0.001),perineural invasion(HR=2.433,p<0.001),CA19-9>81.51KU/ml(HR=2.215,p=0.002),CA125>29.22KU/ml(HR=2.102,p=0.005),CEA>3.77ng/ml(HR=2.323,p=0.001),NLR>2.77(HR=1.925,p=0.009),FPR>13.57(HR=8.772,p<0.001)were significantly correlated with a poor OS.Postoperative adjuvant chemotherapy(HR=0.262,p<0.001)was significantly associated with a better OS.COX multivariate analysis showed that:Histological grade G3-G4(HR=4.246,p<0.001),tumor site in the cystic duct or neck(HR=2.149,p=0.029),high N stage[N1(HR=2.589,p=0.016),N2(HR=4.526,p<0.001)],FPR>13.57(HR=3.409,p=0.038)were independent risk factors for prognosis after radical gallbladder carcinoma surgery.Postoperative adjuvant chemotherapy(HR=0.264,p<0.001)was an independent protective factor for prognosis after gallbladder cancer radical surgery.Conclusions:1.FPR is an effective biomarker with a good sensitivity and a medium specificity for predicting the prognosis of patients after gallbladder cancer radical surgery,and its optimal cut-off value is 13.57.When FPR>13.57,the prognosis of patients is indicated to be poor.Moreover,FPR is easy to be obtained by blood sampling before surgery,which has guiding significance for clinical works such as preoperative prognosis prediction of patients.2.FPR contributes to classify potential beneficiable patients from postoperative adjuvant chemotherapy after gallbladder cancer radical resection,so as to facilitate early detection and guide the postoperative adjuvant chemotherapy.3.FPR>13.57,tumors located in the cystic duct or neck and histological grade of G3-G4,N1 and N2 stages are independent risk factors for prognosis after gallbladder cancer radical surgery,while postoperative adjuvant chemotherapy is an independent protective factor.4.A nomogram model based on FPR,tumors site,histological grade,N stage,and postoperative adjuvant chemotherapy has a good ability to predict the prognosis of patients with gallbladder cancer after radical resection. |
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