Prognostic significance of pretreatment plasma fibrinogen level in patients with digestive system tumors: a meta-analysis

The Prognostic value of the Fibrinogen to pre-albumin ratio in malignant tumors of the digestive system: a systematic review and meta-analysis

Background

In recent years, the Fibrinogen to pre-albumin ratio (FPR) has been reported in many studies to be significantly associated with the prognosis of various cancers. This systematic review and meta-analysis aimed to investigate the prognostic value of FPR in malignant tumors of the digestive system based on available evidence.

Methods

The relevant articles published before July 1, 2021, were systematically retrieved from electronic databases to evaluate the effect of Fibrinogen to pre-albumin ratio (FPR) on the prognosis of patients with malignant digestive system tumors and calculate the hazard ratio (HR) and the corresponding 95% confidence interval (CI).

Result

Thirteen articles, all from China, including 15 cohort studies and a total of 5116 cases, were included in this study. A high FPR was associated with poor overall survival (HR = 1.88, 95%CI 1.53–2.32, P < 0.001), recurrence-free survival (HR = 2.29, 95%CI 1.91–2.76, P < 0.001), progression-free survival (HR = 1.96, 95%CI: 1.33–2.90, P = 0.001), complications (HR = 1.78, 95%CI: 1.06–3.00, P = 0.029), disease-free survival (HR = 1.46, 95%CI: 1.08–1.97, P = 0.013) was significantly associated with cancer-specific survival (HR = 1.44, 95%CI: 1.15–1.79, P = 0.001). Even though intergroup differences were present, FPR was strongly associated with overall and relapse-free survival, and sensitivity analysis suggested that our results were stable.

Conclusion

FPR can be used as a valuable indicator to predict the prognosis of patients with malignant digestive system tumors.

Early Prediction of Objective Response of Fibrinogen in a Real-World Cohort of Hepatocellular Carcinoma Cases Treated by Programmed Cell Death Receptor-1 and Lenvatinib

Background

This cohort study aimed to investigate the influence of fibrinogen on progression-free survival and overall survival in unresectable HCC cases treated by PD-1 and lenvatinib.

Methods

A total of 57 unresectable HCC cases who received lenvatinib and PD-1, such as toripalimab, camrelizumab, or sintilimab, in Beijing Ditan Hospital Affiliated to Capital Medical University were enrolled in this study.

Results

Vascular invasion, high FIB (>2.83g/L), and metastasis were highly correlated with low PFS. There was a significant correlation between a raised risk of death and metastasis and increased FIB (>2.83g/L).

Conclusion

FIB is associated with outcomes of unresectable HCC cases treated by PD-1 and lenvatinib.

Research Progress of Preoperative FPR, FAR or AFR in Patients with Colorectal Cancer

Research has confirmed that plasma albumin (Alb), prealbumin (PA) and fibrinogen (Fib) are involved in regulating the occurrence and development of various tumors. Their levels in peripheral blood are related to the survival outcome and treatment response of patients, but the accuracy and specificity of single application have yet to be fully realized. A growing amount of evidence indicates that predictors such as preoperative fibrinogen to prealbumin ratio (FPR), fibrinogen to albumin ratio (FAR) or albumin to fibrinogen ratio (AFR) are emerging as comprehensive indicators. Indeed, their components play a key regulatory role in the progression of colorectal cancer (CRC). Preoperative FPR, FAR or AFR levels, therefore, are expected to become new biomarkers for prognosis evaluation and curative effect prediction for CRC patients and are significant in the guidance they could provide for the development of individualized treatment strategies.

Prognostic Value of lncRNA NEAT1 as a New Biomarker in Digestive System Tumors: a Systematic Study and Meta-analysis

OBJECTIVE

Nuclear paraspeckle assembly transcript 1 (NEAT1), a newly found lncRNA, is found abnormally expressed in digestive system tumors. This meta-analysis aims to evaluate the effect of NEAT1 on digestive system tumors.

METHODS

An analysis was conducted to investigate NEAT1 expression in digestive system tumors from the PubMed, Embase, and Web of Science databases. The relationship between NEAT1 expression and patient overall survival (OS) and clinicopathology was evaluated by correlation analysis with the pooled hazard ratio (HR), 95% confidence interval (CI), and odds ratio (OR).

RESULTS

A total of 12 published studies were enrolled in this meta-analysis. The NEAT1 overexpression was significantly associated with poor OS (HR = 1.64, 95% CI:1.41-1.91, p < 0.05), lymphatic metastasis (OR = 2.70, 95% CI: 2.02-3.61, p < 0.05), distal metastasis (OR = 3.01, 95% CI: 1.97-4.59, p < 0.05) and advanced tumor stage (OR = 3.04, 95% CI: 2.32-3.99, p < 0.05). However, digestive system tumor patients with high NEAT1 expression was not related to the patients' age (OR = 0.91, 95% CI: 0.65-1.26, p = 0.561), gender (OR = 1.04, 95% CI: 0.81-1.33, p = 0.761), tumor size (OR = 1.84, 95% CI: 0.88-3.88, p = 0.106), and tumor differentiation (OR = 0.86, 95% CI: 0.51-1.44, p = 0.570).

CONCLUSION

Collectively, NEAT1 can be used as a potential biomarker to predict the prognosis of patients with digestive system tumors, which is worth verifying in clinical practice.

The Prognostic Role of a Combined Fibrinogen and Neutrophil-to-Lymphocyte Ratio Score in Patients with Resectable Hepatocellular Carcinoma: A Retrospective Study

Background

Inflammation and activation of the coagulation cascades have a role in the pathogenesis of malignancy, including hepatocellular carcinoma (HCC). This retrospective study aimed to investigate the prognostic role of the combined fibrinogen and neutrophil-to-lymphocyte ratio (F-NLR) in patients with resectable HCC.

Material/Methods

This retrospective study included 292 patients with HCC who underwent surgical resection. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of preoperative fibrinogen (Fib) levels and the neutrophil-to-lymphocyte ratio (NLR). The. Hyperfibrinogenemia was >3.35 g/L, and an increased NLR was ≥2.47. The F-NLR was calculated for all patients. Kaplan-Meier survival curves, univariate analysis, multivariate analysis, and subgroup analysis were used to identify independent prognostic factors for overall survival (OS) and disease-free survival (DFS). The receiver operating characteristic (ROC) curve analysis of the F-NLR score and OS, according to the Barcelona Clinic Liver Cancer (BCLC) stage, was performed.

Results

Increased F-NLR scores were significantly associated with the presence of tumor thrombus (P=0.001), larger tumor diameter (P<0.001), vascular invasion (P<0.001), and increased BCLC stage (P<0.001). Multivariate analysis showed that the F-NLR score was an independent predictor of OS (P<0.001) and DFS (P=0.002). The prognostic role of F-NLR was significant for BCLC stage 0–I (P=0.004; P<0.001) and BCLC stage II–III (P=0.026; P=0.005) for OS and DFS, respectively.

Conclusions

In patients with resectable HCC, the combined F-NLR score, a new indicator of systemic inflammation, was an independent prognostic indicator.

Prognostic value of pretreatment plasma fibrinogen in patients with colorectal cancer: A systematic review and meta-analysis

BACKGROUND

Growing evidence showed that high pretreatment plasma fibrinogen could be used as a potential prognostic marker in colorectal cancer (CRC). However, the conclusions were controversial. Therefore, this meta-analysis was conducted to evaluate the prognostic value of pretreatment plasma fibrinogen in patients with CRC.

METHODS

Relevant studies were searched in the databases including PubMed, EMBASE, Web of Science, Cochrane library, and China National Knowledge Infrastructure up until December 10th, 2018. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to estimate the effects.

RESULTS

A total of 17 articles with 6863 patients were included in this meta-analysis. The results revealed that elevated pretreatment plasma fibrinogen was significantly associated with both poor overall survival (univariate analysis: HR = 1.69, 95% CI 1.47-1.95, P = .000; multivariate analysis: HR = 1.50, 95% CI 1.28-1.77, P = .000) and poor disease-free survival (univariate analysis: HR = 1.90, 95% CI 1.49-2.41, P = .000; multivariate analysis: HR = 2.08, 95% CI 1.52-2.86, P = .000) in patients with CRC.

CONCLUSIONS

High pretreatment plasma fibrinogen level is significantly associated with worse survival outcomes in CRC patients. Plasma fibrinogen may be used as an effective prognostic marker and potential therapeutic target. Further studies are required to support these results.

Prognostic significance of inflammatory-related parameters in patients with anal canal cancer

PURPOSE

To investigate the correlation between inflammatory-related parameters and overall survival (OS) and disease-free survival (DFS) in anal canal cancer population.

METHODS AND MATERIALS

Patients diagnosed with anal canal carcinoma and treated with curative intent chemoradiotherapy (CRT) were included. Data about pre-treatment complete blood count were collected. Neutrophil to lymphocyte ratio (NLR), fibrinogen (F), and a combination of these (F-NLR score) were correlated with OS.

RESULTS

A total of 58 patients were enrolled. In multivariate analysis, the strongest OS prognostic factor was NLR, with a hazard ratio (HR) for low NLR compared to high NLR of 1.30 (95% confidence interval 1.01-14.12). Kaplan-Meier survival analysis showed that patients with high NLR, F, and F-NLR had significantly shorter OS and DFS.

CONCLUSION

To our knowledge, this is the first study providing evidence that elevated pre-treatment NLR, F, and F-NLR score significantly correlate with worse survival outcomes in patients with anal canal carcinoma. In view of our findings, future clinical trials in anal canal cancer patients are warranted to verify our results.

Prognostic value of small nuclear RNAs (snRNAs) for digestive tract pan- adenocarcinomas identified by RNA sequencing data

Malignant tumors of the digestive tract include esophageal, gastric, and colorectal carcinomas, which all have high global mortality rates. A clinical role for small nuclear RNA (snRNA), a type of small non-coding RNA, has not yet been documented for digestive tract pan-adenocarcinomas. Therefore, the aim of the study was to identify differentially expressed snRNAs and to explore their prognostic implications in pan-adenocarcinomas from the esophagus, stomach, colon, and rectum. The pan-carcinoma RNA-sequencing data of four types of digestive tract cancers with 1, 102 cases obtained from The Cancer Genome Atlas (TCGA) project were analyzed and the differentially expressed snRNAs were evaluated using the edgeR package. The prognostic value of each of the selected snRNAs was determined by univariate and multivariate Cox regression analyses. All the digestive tract pan-adenocarcinomas showed differential expression of three snRNAs: the up-regulated RNU1-106 P and RNU6-850 P and the down-regulated RNU6-529 P. Interestingly, RNU6-101 P appeared to be a risk factor for esophageal adenocarcinoma (ESAD) and RNVU1-4 was potentially a protective factor for stomach adenocarcinoma (STAD) survival. This consistent finding of differential expression of all three snRNAs in all four types of digestive system cancers suggests potential roles for these snRNAs in the tumorigenesis of digestive system cancers. RNU6-101 P could play a pivotal role in the progression of ESAD and RNVU1-4 could perform a protective role in STAD. However, since the current findings were based on RNA-sequencing data mining, more studies are needed for verification.