Role of Chronic Inflammatory Ratios in Predicting Recurrence of Resected Patients with Stage I-III Mucinous Colorectal Adenocarcinoma

Yu-Cui Liao,1,* Hou-Qun Ying,2,* Ying Huang,3,* Yan-Ran Luo,3 Cui-Fen Xiong,3 Ruo-Wei Nie,3 Xiao-Juan Li,4 Xue-Xin Cheng1 1School of Public Health; Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China; 2Department of Nuclear Medicine, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China; 3Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China; 4Department of Clinical Laboratory, Kunming Children’s Hospital, Kunming, Yunnan, 650500, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xue-Xin ChengSchool of Public Health; Jiangxi Provincial Key Laboratory of Preventive Medicine Nanchang University, No. 1 Of Minde Road, Nanchang, People’s Republic of ChinaTel/Fax +86 0791-86297662Email cxxncu@163.comBackground: Cancer-related inflammation is the main cause of the progression of mucinous colorectal adenocarcinoma (MCA). Circulating fibrinogen-to-pre-albumin ratio (FPR) is associated with the clinical outcome in colorectal cancer (CRC). However, the prognostic role of FPR and which is the best inflammatory prognostic biomarker within MCA remain unknown.Methods: We enrolled 157 patients with stage I–III MCA in this study. Kaplan-Meier curve, Cox regression, and time-dependent receiver operation characteristic curve analysis were performed to assess the prognostic value and efficacy of the neutrophil-to-albumin ratio (NAR), neutrophil-to-pre-albumin ratio (NPAR), albumin-to-alkaline phosphatase ratio (AAPR), albumin-to-globulin ratio (AGR), albumin-to-fibrinogen ratio (AFR), and FPR in these patients.Results:: We found that NAR, NPAR, and FPR were significantly associated with unsatisfactory recurrence-free survival (RFS) in patients with stage I–III MCA, and the predicted efficacy of FPR was superior to that of the other two inflammatory biomarkers. Moreover, patients with a high combined TNM-CA199-FPR score had worse outcomes, with a high predicted efficacy of up to 0.779 (0.703– 0.856). Using FPR, the patient was monitored for the recurrence up to two months earlier than that achieved using the common imaging techniques (4 vs 6 median months) in stage I–III MCA patients undergoing radical resection.Conclusion: FPR is the preferred inflammatory biomarker and commonly used for predicting and monitoring recurrence in stage I–III MCA patients. The combined TNM-CA199-FPR score is an economical, simple, effective, and independent prognostic factor for localized disease.Keywords: mucinous colorectal carcinoma, fibrinogen-to-pre-albumin ratio, prognosis, inflammation