Evaluation of Preoperative Fibrinogen/albumin Ratio and Carcinoembryonic Antigen: a New Prognostic Marker in Gastric Cancer

Abstract Purpose Gastric cancer (GC) is one of the most common cancers that can result in death. Markers are needed to detect gastric cancer early and manage treatment. We aimed to reveal the relationship between carcinoembryonic antigen (CEA) level and Fibrinogen-Albumin ratio (FAR) and prognosis in gastric cancer, as well as to examine the relationship of these values with the number of metastatic lymph nodes and TNM stage.Methods The data of 805 consecutive gastrectomy patients were analyzed retrospectively. A total of 461 patients were included. The optimal cut-off values of CEA and FAR were 2.43 ng/mL and 1.26, respectively. Patients were stratified into three groups based on this cutoff value: CEA-FAR=0 (CEA <2.43 ng/mL and FAR <1.26), CEA-FAR=1 (CEA ≥2.43 ng/mL or FAR ≥1.26), and CEA-FAR=2 (CEA ≥2.43 ng/mL and FAR ≥1.26).Results There was a significant relationship between high CEA and stage (p=0.040), N status (p=0.017), and lymph node metastasis (p=0.004), and also there was a significant correlation between high FAR value and grade (p=0.003), stage (p<0.001), T status (p<0.001), N status (p<0.001) and metastatic lymph node count (p<0.001). Overall and disease-free survival were significantly different between the three CEA-FAR groupsConclusions We believe that pre-operative FAR and CEA values are independent predictors of survival. FAR and CEA are potential prognostic indicators for resectable gastric cancer due to their easy access and low cost. Considering survival and prognosis in patients with very high preoperative CEA and FAR values, neoadjuvant chemotherapy should also be considered.