A cumulative score based on preoperative fibrinogen and the neutrophil–lymphocyte ratio to predict outcomes in resectable gastric cancer

BACKGROUND: Recent studies have revealed that preoperative fibrinogen and the neutrophil–lymphocyte ratio (NLR) are associated with poor outcome in gastric cancer (GC). We aimed to evaluate whether the fibrinogen and the NLR score had a consistent prognostic value for resectable GC. METHODS: We analyzed 1,293 consecutive patients who underwent curative surgery for GC. The F-NLR score was 2 for patients with hyperfibrinogenemia (>400 mg/dL) and elevated NLR (≥5.0), 1 for those with one abnormal index, and 0 for those with no abnormal indices. RESULTS: We found that higher F-NLR scores were associated with larger tumor size, deeper tumor invasion and more lymph node metastasis (all P<0.05). In a multivariate analysis, F-NLR independently predicted postoperative survival (P<0.001). When stratified by tumor–node–metastasis (TNM) stage, the prognostic value of F-NLR was still maintained for stages I–II (P<0.001) and stage III (P=0.003). Of note, F-NLR also effectively stratified overall survival (OS) irrespective of age, adjuvant chemotherapy administration, tumor location and histological grade (all P<0.05). Furthermore, F-NLR and TNM stratified 5-year OS from 61% (F-NLR 0) to 15% (F-NLR 2) and from 92% (stage I) to 37% (stage III), respectively. Utilizing both F-NLR and TNM, 5-year OS ranged from 93% (F-NLR 0, TNM I) to 6% (F-NLR 2, TNM III). CONCLUSION: The F-NLR score independently predicts outcomes in GC patients after curative surgery. Therefore, it should be implemented in routine clinical practice for identifying more high-risk patients.