Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients.

Background: The prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin-bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients.
Methods: This retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan-Meier method, and log-rank test.
Results: The study enrolled 123 untreated mCRC patients. Univariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p > 0.05 for all). However, a higher FIB-4 index (p = 0.025), ALBI score (p < 0.001), GPR (p < 0.001), and AST/ALT ratio (p < 0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009-1.053, p = 0.006), ALBI score (95% CI: 1.234-2.983, p = 0.004), GPR (95% CI: 1.442-2.701, p < 0.001), and AST/ALT (95% CI: 1.193-2.911, p = 0.006) were independent prognostic factors for OS.
Conclusion: The affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC.
Competing Interests: Declarations. Ethics approval and consent to participate: The Clinical Research Ethics Committee of Health Sciences University Gazi Yaşargil Research and Training Hospital approved the study protocol (approval date and number: 2024- 111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled, and the need for consent to participate was waived by The Clinical Research Ethics Committee of Health Sciences University Gazi Yaşargil Research and Training Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2025. The Author(s).)