Prognostic value of the preoperative fibrinogen-to-albumin ratio in pancreatic ductal adenocarcinoma patients undergoing R0 resection

Table 1 Baseline characteristics of 282 pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)

Characteristic	Patients, n = 282
Age in yr	61 (31-81)
> 60	136 (48.2)
≤ 60	146 (51.8)
Sex
Male	151 (53.5)
Female	131 (46.5)
Clinical symptoms
Absent	57 (20.2)
Present	225 (79.8)
Diabetes
Absent	201 (71.3)
Present	81 (28.7)
Smoking status
Absent	215 (76.2)
Present	67 (23.8)
Alcohol consumption
Absent	235 (83.3)
Present	47 (16.7)
Family history of cancer
Absent	271 (96.1)
Present	11 (3.9)
Blood type
A	87 (30.9)
B	93 (33.0)
AB	22 (7.8)
O	80 (28.4)
Tumor location
Head and neck	130 (46.1)
Body and tail	152 (53.9)
Approaches of open surgery
Pancreaticoduodenectomy	130 (46.1)
Distal pancreatectomy with splenectomy	152 (53.9)
Degree of differentiation
Well	34 (12.1)
Moderately	217 (77.0)
Poorly	31 (11.0)
Lymphovascular invasion
Absent	203 (72.0)
Present	79 (28.0)
Perineural invasion
Absent	70 (24.8)
Present	212 (75.2)
Capsular invasion
Absent	49 (17.4)
Present	233 (82.6)
Maximum tumor diameter in cm
> 4	88 (31.2)
≤ 4	194 (68.8)
T stage
T1	34 (12.1)
T2	159 (56.4)
T3	89 (31.6)
Number of metastatic lymph nodes
Absent	161 (57.1)
Present	121 (42.9)
N stage
N0	161 (57.1)
N1	92 (32.6)
N2	29 (10.3)
TNM stage
IA	20 (7.1)
IB	92 (32.6)
IIA	49 (17.4)
IIB	92 (32.6)
III	29 (10.3)
Adjuvant therapy
Absent	124 (44.0)
Present	158 (56.0)
Preoperative CA19-9 level in U/mL	172.4 (0.6-55412.0)
> 336.4	77 (27.3)
≤ 336.4	205 (72.7)
Preoperative plasma fibrinogen concentration in g/L	3.02 (1.20-6.70)
> 3.31	141 (50.0)
≤ 3.31	141 (50.0)
Preoperative plasma albumin level in g/L	42.6 (23.2-54.0)
> 45.2	85 (30.1)
≤ 45.2	197 (69.9)
Preoperative FAR	0.07 (0.03-0.21)
> 0.08	126 (44.7)
≤ 0.08	156 (55.3)

FAR: Fibrinogen-to-albumin ratio; TNM: Tumor-Node-Metastasis.

Table 2 Correlation between preoperative plasma fibrinogen concentration and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)

Characteristics	Preoperative plasma fibrinogen concentration		P value
	> 3.31 g/L, n = 141	≤ 3.31 g/L, n = 141
Age in yr			0.812
> 60	72 (25.5)	74 (26.2)
≤ 60	69 (24.5)	67 (23.8)
Sex			0.283
Male	71 (25.2)	80 (28.4)
Female	70 (24.8)	61 (21.6)
Clinical symptoms			< 0.001
Absent	15 (5.3)	42 (14.9)
Present	126 (44.7)	99 (35.1)
Diabetes			0.357
Absent	97 (34.4)	104 (36.9)
Present	44 (15.6)	37 (13.1)
Smoking status			0.889
Absent	107 (37.9)	108 (38.3)
Present	34 (12.1)	33 (11.7)
Alcohol consumption			0.263
Absent	121 (42.9)	114 (40.4)
Present	20 (7.1)	27 (9.6)
Family history of cancer			0.356
Absent	137 (48.6)	134 (47.5)
Present	4 (1.4)	7 (2.5)
Blood type			0.565
A	39 (13.8)	48 (17.0)
B	51 (18.1)	42 (14.9)
AB	10 (3.5)	12 (4.3)
O	41 (14.5)	39 (13.8)
Tumor location			< 0.001
Head and neck	80 (28.4)	50 (17.7)
Body and tail	61 (21.6)	91 (32.3)
Approaches of open surgery			< 0.001
Pancreaticoduodenectomy	80 (28.4)	50 (17.7)
Distal pancreatectomy with splenectomy	61 (21.6)	91 (32.3)
Degree of differentiation			0.079
Well	20 (7.1)	14 (5.0)
Moderately	111 (39.4)	106 (37.6)
Poorly	10 (3.5)	21 (7.4)
Lymphovascular invasion			0.233
Absent	97 (34.4)	106 (37.6)
Present	44 (15.6)	35 (12.4)
Perineural invasion			0.054
Absent	28 (9.9)	42 (14.9)
Present	113 (40.1)	99 (35.1)
Capsular invasion			0.271
Absent	21 (7.4)	28 (9.9)
Present	120 (42.6)	113 (40.1)
Maximum tumor diameter in cm			1.000
> 4	44 (15.6)	44 (15.6)
≤ 4	97 (34.4)	97 (34.4)
T stage			0.991
T1	17 (6.0)	17 (6.0)
T2	80 (28.4)	79 (28.0)
T3	44 (15.6)	45 (16.0)
Number of metastatic lymph nodes			0.718
Absent	82 (29.1)	79 (28.0)
Present	59 (20.9)	62 (22.0)
N stage			0.110
N0	82 (29.1)	79 (28.0)
N1	40 (14.2)	52 (18.4)
N2	19 (6.7)	10 (3.5)
TNM stage			0.099
IA	8 (2.8)	12 (4.3)
IB	44 (15.6)	48 (17.0)
IIA	30 (10.6)	19 (6.7)
IIB	40 (14.2)	52 (18.4)
III	19 (6.7)	10 (3.5)
Adjuvant therapy			0.631
Absent	64 (22.7)	60 (21.3)
Present	77 (27.3)	81 (28.7)
Preoperative CA19-9 level in U/mL			0.023
> 336.4	47 (16.7)	30 (10.6)
≤ 336.4	94 (33.3)	111 (39.4)
Preoperative plasma albumin level in g/L			0.006
> 45.2	32 (11.3)	53 (18.8)
≤ 45.2	109 (38.2)	88 (31.2)
Preoperative FAR			< 0.001
> 0.08	114 (40.4)	12 (4.3)
≤ 0.08	27 (9.6)	129 (45.7)

FAR: Fibrinogen-to-albumin ratio; TNM: Tumor-Node-Metastasis.

Table 3 Correlation between preoperative plasma albumin level and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)

Characteristics	Preoperative plasma albumin level		P value
	> 45.2 g/L, n = 85	≤ 45.2 g/L, n = 197
Age in yr			0.602
> 60	42 (14.9)	104 (36.9)
≤ 60	43 (15.2)	93 (33.0)
Sex			0.699
Male	47 (16.7)	104 (36.9)
Female	38 (13.5)	93 (33.0)
Clinical symptoms			0.012
Absent	25 (8.9)	32 (11.3)
Present	60 (21.3)	165 (58.5)
Diabetes			0.458
Absent	58 (20.6)	143 (50.7)
Present	27 (9.6)	54 (19.1)
Smoking status			0.806
Absent	64 (22.7)	151 (53.5)
Present	21 (7.4)	46 (16.3)
Alcohol consumption			0.523
Absent	69 (24.5)	166 (58.9)
Present	16 (5.7)	31 (11.0)
Family history of cancer			0.832
Absent	82 (29.1)	189 (67.0)
Present	3 (1.1)	8 (2.8)
Blood type			0.169
A	33 (11.7)	54 (19.1)
B	22 (7.8)	71 (25.2)
AB	8 (2.8)	14 (5.0)
O	22 (7.8)	58 (20.6)
Tumor location			< 0.001
Head and neck	24 (8.5)	106 (37.6)
Body and tail	61 (21.6)	91 (32.3)
Approaches of open surgery			< 0.001
Pancreaticoduodenectomy	24 (8.5)	106 (37.6)
Distal pancreatectomy with splenectomy	61 (21.6)	91 (32.3)
Degree of differentiation			0.567
Well	8 (2.8)	26 (9.2)
Moderately	66 (23.4)	151 (53.5)
Poorly	11 (3.9)	20 (7.1)
Lymphovascular invasion			0.814
Absent	62 (22.0)	141 (50.0)
Present	23 (8.2)	56 (19.9)
Perineural invasion			0.741
Absent	20 (7.1)	50 (17.7)
Present	65 (23.0)	147 (52.1)
Capsular invasion			0.673
Absent	16 (5.7)	33 (11.7)
Present	69 (24.5)	164 (58.2)
Maximum tumor diameter in cm			0.330
> 4	30 (10.6)	58 (20.6)
≤ 4	55 (19.5)	139 (49.3)
T stage			0.530
T1	8 (2.8)	26 (9.2)
T2	47 (16.7)	112 (39.7)
T3	30 (10.6)	59 (20.9)
Number of metastatic lymph nodes			0.363
Absent	52 (18.4)	109 (38.7)
Present	33 (11.7)	88 (31.2)
N stage			0.127
N0	52 (18.4)	109 (38.7)
N1	29 (10.3)	63 (22.3)
N2	4 (1.4)	25 (8.9)
TNM stage			0.145
IA	4 (1.4)	16 (5.7)
IB	34 (12.1)	58 (20.6)
IIA	14 (5.0)	35 (12.4)
IIB	29 (10.3)	63 (22.3)
III	4 (1.4)	25 (8.9)
Adjuvant therapy			0.003
Absent	26 (9.2)	98 (34.8)
Present	59 (20.9)	99 (35.1)
Preoperative CA19-9 level in U/mL			0.416
> 336.4	26 (9.2)	51 (18.1)
≤ 336.4	59 (20.9)	146 (51.8)
Preoperative plasma fibrinogen concentration in g/L			0.006
> 3.31	32 (11.3)	109 (38.7)
≤ 3.31	53 (18.8)	88 (31.2)
Preoperative FAR			< 0.001
> 0.08	15 (5.3)	111 (39.4)
≤ 0.08	70 (24.8)	86 (30.5)

FAR: Fibrinogen-to-albumin ratio; TNM: Tumor-Node-Metastasis.

Table 4 Correlation between preoperative fibrinogen-to-albumin ratio and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)

Characteristic	Preoperative FAR		P value
	> 0.08, n = 126	≤ 0.08, n = 156
Age in yr			0.854
> 60	66 (23.4)	80 (28.4)
≤ 60	60 (21.3)	76 (27.0)
Sex			0.724
Male	66 (23.4)	85 (30.1)
Female	60 (21.3)	71 (25.2)
Clinical symptoms			0.001
Absent	14 (5.0)	43 (15.2)
Present	112 (39.7)	113 (40.1)
Diabetes			0.831
Absent	89 (31.6)	112 (39.7)
Present	37 (13.1)	44 (15.6)
Smoking status			0.765
Absent	95 (33.7)	120 (42.6)
Present	31 (11.0)	36 (12.8)
Alcohol consumption			0.335
Absent	108 (38.3)	127 (45.0)
Present	18 (6.4)	29 (10.3)
Family history of cancer			0.571
Absent	122 (43.3)	149 (52.8)
Present	4 (1.4)	7 (2.5)
Blood type			0.817
A	36 (12.8)	51 (18.1)
B	45 (16.0)	48 (17.0)
AB	10 (3.5)	12 (4.3)
O	35 (12.4)	45 (16.0)
Tumor location			< 0.001
Head and neck	77 (27.3)	53 (18.8)
Body and tail	49 (17.4)	103 (36.5)
Approaches of open surgery			< 0.001
Pancreaticoduodenectomy	77 (27.3)	53 (18.8)
Distal pancreatectomy with splenectomy	49 (17.4)	103 (36.5)
Degree of differentiation			0.208
Well	20 (7.1)	14 (5.0)
Moderately	93 (33.0)	124 (44.0)
Poorly	13 (4.6)	18 (6.4)
Lymphovascular invasion			0.729
Absent	92 (32.6)	111 (39.4)
Present	34 (12.1)	45 (16.0)
Perineural invasion			0.082
Absent	25 (8.9)	45 (16.0)
Present	101 (35.8)	111 (39.4)
Capsular invasion			0.360
Absent	19 (6.7)	30 (10.6)
Present	107 (37.9)	126 (44.7)
Maximum tumor diameter in cm			0.391
> 4	36 (12.8)	52 (18.4)
≤ 4	90 (31.9)	104 (36.9)
T stage			0.462
T1	13 (4.6)	21 (7.4)
T2	76 (27.0)	83 (29.4)
T3	37 (13.1)	52 (18.4)
Number of metastatic lymph nodes			0.988
Absent	72 (25.5)	89 (31.6)
Present	54 (19.1)	67 (23.8)
N stage			0.902
N0	72 (25.5)	89 (31.6)
N1	40 (14.2)	52 (18.4)
N2	14 (5.0)	15 (5.3)
TNM stage			0.494
IA	6 (2.1)	14 (5.0)
IB	40 (14.2)	52 (18.4)
IIA	26 (9.2)	23 (8.2)
IIB	40 (14.2)	52 (18.4)
III	14 (5.0)	15 (5.3)
Adjuvant therapy			0.531
Absent	58 (20.6)	66 (23.4)
Present	68 (24.1)	90 (31.9)
Preoperative CA19-9 level in U/mL			0.132
> 336.4	40 (14.2)	37 (13.1)
≤ 336.4	86 (30.5)	119 (42.2)
Preoperative plasma fibrinogen concentration in g/L			< 0.001
> 3.31	114 (40.4)	27 (9.6)
≤ 3.31	12 (4.3)	129 (45.7)
Preoperative plasma albumin level in g/L			< 0.001
> 45.2	15 (5.3)	70 (24.8)
≤ 45.2	111 (39.4)	86 (30.5)

FAR: Fibrinogen-to-albumin ratio; TNM: Tumor-Node-Metastasis.

Table 5 Univariate analysis for overall survival in pancreatic ductal adenocarcinoma patients who underwent R0 resection

Characteristic	HR (95%CI)	P value
Age in yr	1.358 (1.036-1.780)	0.027
> 60
≤ 60
Sex	1.281 (0.979-1.675)	0.071
Male
Female
Clinical symptoms	0.600 (0.424-0.848)	0.004
Absent
Present
Diabetes	0.903 (0.676-1.206)	0.491
Absent
Present
Smoking status	0.866 (0.635-1.181)	0.363
Absent
Present
Alcohol consumption	1.083 (0.754-1.556)	0.667
Absent
Present
Family history of cancer	1.251 (0.617-2.537)	0.535
Absent
Present
Blood type	—	0.579
A
B
AB
O
Tumor location	0.954 (0.729-1.249)	0.731
Head and neck
Body and tail
Approaches of open surgery	0.954 (0.729-1.249)	0.731
Pancreaticoduodenectomy
Distal pancreatectomy with splenectomy
Degree of differentiation	—	< 0.001
Well
Moderately
Poorly
Lymphovascular invasion	0.793 (0.590-1.065)	0.123
Absent
Present
Perineural invasion	0.905 (0.666-1.231)	0.525
Absent
Present
Capsular invasion	0.609 (0.420-0.885)	0.009
Absent
Present
Maximum tumor diameter in cm	1.403 (1.058-1.862)	0.019
> 4
≤ 4
T stage	—	0.035
T1
T2
T3
Number of metastatic lymph nodes	0.590 (0.449-0.775)	< 0.001
Absent
Present
N stage		0.001
N0
N1
N2
TNM stage		0.003
IA
IB
IIA
IIB
III
Adjuvant therapy	1.625 (1.244-2.123)	< 0.001
Absent
Present
Preoperative CA19-9 level in U/mL	1.971 (1.469-2.644)	< 0.001
> 336.4
≤ 336.4
Preoperative plasma fibrinogen concentration in g/L	1.888 (1.438-2.479)	< 0.001
> 3.31
≤ 3.31
Preoperative plasma albumin level in g/L	0.650 (0.475-0.890)	0.007
> 45.2
≤ 45.2
Preoperative FAR	2.257 (1.725-2.952)	< 0.001
> 0.08
≤ 0.08

CI: Confidence interval; FAR: Fibrinogen-to-albumin ratio; HR: Hazard ratio.

Table 6 Multivariate analysis for overall survival in pancreatic ductal adenocarcinoma patients who underwent R0 resection

Characteristics	HR (95%CI)	Wald	P value
Age in yr	1.289 (0.971-1.710)	3.076	0.079
> 60
≤ 60
Degree of differentiation		31.261	< 0.001
Poorly/well	5.209 (2.837-9.562)	28.353	< 0.001
Moderately/well	1.912 (1.184-3.085)	7.037	0.008
Capsular invasion	0.697 (0.475-1.022)	3.409	0.065
Absent
Present
Maximum tumor diameter in cm	1.296 (0.959-1.751)	2.843	0.092
> 4
≤ 4
Number of metastatic lymph nodes	0.678 (0.509-0.904)	7,027	0.008
Absent
Present
Adjuvant therapy	1.604 (1.214-2.118)	11.058	0.001
Absent
Present
Preoperative CA19-9 level in U/mL	1.740 (1.288-2.352)	13.003	< 0.001
> 336.4
≤ 336.4
Preoperative FAR	2.258 (1.720-2.963)	34.468	< 0.001
> 0.08
≤ 0.08

CI: Confidence interval; FAR: Fibrinogen-to-albumin ratio; HR: Hazard ratio.