Prognostic value of preoperative albumin-to-fibrinogen ratio (AFR) in patients with bladder cancer treated with radical cystectomy

Introduction and objectives: To evaluate the prognostic role of albumin-to-fibrinogen ratio (AFR) for the prediction of ontological outcomes in a multi-institutional cohort of bladder cancer (BC) patients treated with radical cystectomy (RC). Materials and methods: We retrospectively analyzed a multicenter cohort of patients treated with upfront RC for localized (cT1-4aNOMO) BC. Multivariable logistic regression analyses were performed to evaluate the ability of AFR to predict non-organ confined (NOC) disease and lymph-node involvement (LNI) at time of RC. Multivariable Cox' regression models were performed to evaluate the prognostic effect of AFR on Time-to-Progression (TTP), overall survival (OS), and cancer-specific survival (CSS). Results: A cut-off value to discriminate between low and high AFR was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.73 with an optimal cut-off at 9.53. Data were available for 246 patients (91 with low AFR, 155 with high AFR). Low AFR was associated with characteristics of tumor aggressiveness and independently predicted NOC (OR 2.11, P = 0.02) and LNI (OR 1.58, P = 0.04) at final pathological report. On multivariable Cox' regression analyses, preoperative low AFR was independently associated with worse TTP (HR 2.21, P = 0.02), OS (HR 2.24, P = 0.03), and CSS (HR 2.70, P = 0.01). Conclusion: Preoperative low AFR is a prognostic biomarker for worse TTP, OS, CSS, and is independently associated with adverse tumor pathological features in BC patients undergoing RC. Our results suggest that especially patients with low AFR may be considered for neoadjuvant treatment. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

The study evaluated the prognostic role of albumin-to-fibrinogen ratio (AFR) in bladder cancer patients undergoing radical cystectomy (RC), with preoperative low AFR independently associated with worse outcomes. These results suggest that patients with low AFR may benefit from neoadjuvant treatment.