Abstract
PURPOSE: The aim of this study was to investigate the clinical significance of the combined fibrinogen and neutrophil-lymphocyte ratio (F-NLR) in patients with resectable colorectal cancer (CRC). PATIENTS AND METHODS: We retrospectively recruited 693 patients with stage I-III CRC following curative surgery. Cutoff values of the preoperative fibrinogen and neutrophil-lymphocyte ratio (NLR) were determined with the receiver operating characteristic analysis. Patients were divided into three groups based on the F-NLR value and were further divided into the chemotherapy and nonchemotherapy groups. The overall survival (OS) and disease-free survival (DFS) were evaluated with the Kaplan-Meier survival method, the log-rank test, univariate and multivariate Cox proportional hazards models, and subgroup analyses. RESULTS: The Kaplan-Meier survival curves revealed that the 5-year OS rates in the F-NLR 0, 1, and 2 groups were 78.4%, 52%, 42.6%, respectively (P<0.001), and the 5-year DFS rates were 54.9%, 43.9%, 26.7%, respectively (P<0.001). Multivariate analyses revealed that the F-NLR score was an independent prognostic factor for both the OS (P=0.035) and the DFS (P=0.001). In addition, subgroup analyses based on the histological type showed that an elevated F-NLR score was significantly associated with worse OS (P=0.001) and DFS (P<0.001) in patients with colorectal adenocarcinoma. Furthermore, DFS in the F-NLR 0-1 group was significantly shortened after the administration of chemotherapy (P=0.005); however, patients with a relatively higher F-NLR score showed slight OS benefit from adjuvant chemotherapy (P=0.144). CONCLUSION: The F-NLR score, as a novel inflammation-based grading index, was a potential predictor for the prognosis and responses to chemotherapy in patients with resectable CRC.