J Breast Cancer.  2017 Sep;20(3):254-263. 10.4048/jbc.2017.20.3.254.

Prognostic Influence of Preoperative Fibrinogen to Albumin Ratio for Breast Cancer

• Hwang KT
• Chung JK
• Roh EY
• Kim J
• Oh S
• Kim YA
• Rhu J
• Kim S

• KMID: 2438992
• DOI: http://doi.org/10.4048/jbc.2017.20.3.254

Abstract

PURPOSE
Elevated serum concentration of fibrinogen and decreased serum concentration of albumin have been reported to be markers of elevated systemic inflammation. We attempted to investigate the prognostic influence of preoperative fibrinogen to albumin ratio (FAR) for breast cancer.
METHODS
Data from 793 consecutive primary breast cancer patients were retrospectively analyzed. Serum levels of fibrinogen and albumin were tested before curative surgery. Subjects were grouped into two groups according to the cutoff value determined by performing the receiver operating characteristic curve analysis: the high FAR group (FAR>7.1) and the low FAR group (FAR≤7.1). Overall survival was assessed using the Kaplan-Meier estimator. Independent prognostic significance was analyzed using the Cox proportional hazards model.
RESULTS
The high FAR group had a worse prognosis compared to the low FAR group (log-rank test, p<0.001). The prognostic effect of FAR was more significant than that of single markers such as fibrinogen (log-rank test, p=0.001) or albumin (log-rank test, p=0.001). The prognostic effect of FAR was prominent in the stage II/III subgroup (log-rank test, p<0.001) and luminal A-like subtype (log-rank test, p<0.001). FAR was identified as a significant independent factor on both univariate (hazard ratio [HR], 2.722; 95% confidence interval [CI], 1.659-4.468; p<0.001) and multivariate analysis (HR, 2.622; 95% CI, 1.455-4.724; p=0.001).
CONCLUSION
Preoperative FAR was a strong independent prognostic factor in breast cancer. Its prognostic effect was more prominent in the stage II/III subgroup and in the luminal A-like subtype. Therefore, preoperative FAR can be utilized as a useful prognosticator for breast cancer patients. Further studies are needed to validate its applications in clinical settings.

Keyword

Breast neoplasms; Fibrinogen; Prognosis; Serum albumin; Survival analysis

MeSH Terms

Breast Neoplasms*
Breast*
Fibrinogen*
Humans
Inflammation
Multivariate Analysis
Phenobarbital
Prognosis
Proportional Hazards Models
Retrospective Studies
ROC Curve
Serum Albumin
Survival Analysis
Fibrinogen
Phenobarbital
Serum Albumin

Figure

• 

  Figure 1 Overall survival curves according to fibrinogen (A), albumin (B), the fibrinogen to albumin ratio (FAR) (C), and a receiver operating characteristic (ROC) curve for the FAR (D).

• 

  Figure 2 Subgroup analyses with a forest plot for the effect of the fibrinogen to albumin ratio with respect to overall survival according to clinicopathologic characteristics.HR=hazard ratio; CI=confidence interval; HER2=human epidermal growth factor receptor 2.*In the forest plot, a HR value more than 1 favors low fibrinogen to albumin ratio against high fibrinogen to albumin ratio. Red color means a statistical significance and blue color means no statistical significance.

• 

  Figure 3 Overall survival curves for the FAR according to the stages; stage I (A), stage II (B), stage III (C), and stage II/III (D).FAR=fibrinogen to albumin ratio.

• 

  Figure 4 Overall survival curves for the fibrinogen to albumin ratio (FAR) according to the molecular subtypes; luminal A-like (A), luminal B-like (B), human epidermal growth factor receptor 2 (HER2) (C), and triple negative (D).

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