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Preoperative circulating FPR and CCF score are promising biomarkers for predicting clinical outcome of stage II–III colorectal cancer patients

Authors Sun F, Peng HX, Gao QF, Li SQ, Zhang J, Chen QG, Jiang YH, Zhang L, Wang XZ, Ying HQ

Received 6 March 2018

Accepted for publication 24 April 2018

Published 19 July 2018 Volume 2018:10 Pages 2151—2161


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Leylah Drusbosky

Fan Sun,1,* Hong-Xin Peng,2,* Qiu-Fang Gao,1 Shu-Qi Li,1 Jing Zhang,1 Qing-Gen Chen,1 Yu-Huan Jiang,1 Lei Zhang,1 Xiao-Zhong Wang,1 Hou-Qun Ying1

1Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China; 2Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China

*These authors contributed equally to this work

Introduction: Inflammation and nutrition are considered as two important causes leading to the progression and poor survival of colorectal cancer (CRC). The objective of this study is to investigate the prognostic significance of preoperative albumin-to-fibrinogen ratio (AFR), fibrinogen-to-pre-albumin ratio (FPR), fibrinogen (Fib), albumin (Alb), and pre-albumin (pre-Alb) in CRC individuals.
Materials and methods: In this study, 3 years’ follow-up was carried out in 702 stage I–III resected CRC patients diagnosed between January 2008 and December 2013. The optimal cutoff points and prognostic values of AFR, FPR, Fib, Alb, pre-Alb, and a novel carcinoembryonic antigen (CEA)-carbohydrate antigen 19-9 (CA199)-FPR (CCF) score were assessed by X-tile software, Kaplan–Meier curve, and Cox regression model. We established the CRC prognostic nomogram, and its predictive efficacy was determined by Harrell’s concordance index (c-index).
Results: Our results showed that high FPR was obviously correlated with poor survival of CRC patients. The prognostic predictive efficacy of CCF score was superior to FPR, CEA, CA199, CEA-CA199 (CCI), and CEA-FPR (CFI) score. Moreover, stage II–III patients harboring high FPR or elevated CCF (score≥1) could benefit from adjuvant chemotherapy, rather than those with low FPR or CCF (score=0). Additionally, the c-index (0.728) of the nomogram containing CCF score was significantly higher than that (0.626) without it (p<0.01).
Conclusion: These findings illustrated that FPR and CCF score were promising biomarkers to predict the prognosis of CRC and to classify the stage II–III patients who could benefit from the adjuvant chemotherapy.

Keywords: inflammation, colorectal cancer, FPR, CCF score, survival

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