Prognostic significance of the ratio of fibrinogen and albumin in human malignancies: a meta-analysis

Background and aim: Serum fibrinogen and albumin are two important factors in systemic inflammation and these two factors are related to tumor progression. This study aimed to comprehensively reveal the prognostic value of the ratio of fibrinogen and albumin in malignant tumors. Methods: We systematically searched relevant studies in PubMed, Web of Science and Embase up to November 21, 2018. Hazard ratios (HRs) or odds ratio (ORs) for overall survival (OS)/disease-free survival (DFS), as well as relevant clinical data, were collected for analysis; all data analyses were performed by using STATA/SE 14. Results: Twelve cohort studies were included in this meta-analysis, with a total of 5,088 cases including 9 different kinds of tumors recruited. The pooled results showed that high albumin/fibrinogen ratio (FAR) and low fibrinogen/albumin ratio (AFR) were significantly associated with poor OS (HR=1.50, 95% CI: 1.30-1.70). Subgroup analyses for OS were also performed based on the disease type, detection method, follow-up time and treatment. Similarly, high FAR or low AFR indicated a worse DFS in cancer patients (HR=1.86; 95% CI: 1.41-2.31). In addition, high FAR or low AFR was statistically significant in relation to deeper tumor infiltration (OR=2.81, 95%CI: 1.67-4.72), positive lymph node metastasis (OR=1.57, 95%CI: 1.23-2.02) and distant metastasis (OR=2.30, 95% CI: 1.36-3.89) as well as advanced clinical stage (OR=2.02, 95% CI: 1.17-3.47). Conclusions: The ratio of fibrinogen and albumin could act as a promising prognostic marker in human malignant tumors. It might assist physicians to select optimal treatments by identifying the current status of the patient. Future multicenter clinical trials are needed to validate its applications.