The Prognostic Value of Preoperative Fibrinogen and Its Combination With Platelet-Lymphocyte Ratio in Oral Squamous Cell Carcinoma.

BACKGROUND

Oral squamous cell carcinoma (OSCC) has a poor prognosis. The prognostic value of fibrinogen (Fib), platelet-lymphocyte ratio (PLR), and their combined F-PLR (Fibrinogen-PLR) score in OSCC remains uncertain.

PURPOSE: The purpose of the study was to measure the associations of preoperative Fib, PLR, and F-PLR score with overall survival (OS) and progression-free survival (PFS) in OSCC.

STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study comprised OSCC patients who underwent radical surgery at Shanghai Ninth People's Hospital between December 2017 and December 2020. Exclusion criteria included preoperative radiotherapy/chemotherapy, other malignancies, systemic inflammatory diseases/hematological disorders, or long-term anticoagulant use.

PREDICTOR VARIABLE: The predictor variables were preoperative Fib, PLR, and F-PLR score.

MAIN OUTCOME VARIABLES: The outcome variables were OS and PFS, measured from surgery until death or disease progression.

COVARIATES: Covariates included age, sex, smoking and drinking history, tumor location, depth of tumor invasion, lymph node metastasis, TNM stage, pathologic extranodal extension (ENE), perineural invasion (PNI), lymphovascular invasion (LVI), and margin status.

ANALYSES: Cutoffs were determined using receiver operating characteristic analysis. Kaplan-Meier analysis and Cox regression were conducted. P value of < .05 was considered statistically significant.

RESULTS

The study included 212 subjects (62.7% male) with a median (interquartile range) age of 57 (50 to 64) years. Over a median follow-up of 41 months (interquartile range: 26.5 to 50.5), 26 deaths and 55 disease progression events were observed. The F-PLR score was categorized as "high" (Fib ≥ 2.69 g/L and PLR ≥ 134.72), "medium" (either elevated), and "low" (neither elevated). Multivariable analysis revealed that Fib (hazard ratio [HR]: 5.70, 95% CI: 1.31 to 24.91, P = .017) and high F-PLR (HR: 4.86, 95% CI: 1.05 to 22.54, P = .044) were associated with OS. For PFS, Fib (HR: 2.62, 95% CI: 1.29 to 5.32, P = .008), medium F-PLR (HR: 2.65, 95% CI: 1.14 to 6.20, P = .024), and high F-PLR (HR: 3.36, 95% CI: 1.44 to 7.85, P = .005) were associated with PFS. The F-PLR score allowed for refined risk stratification by identifying an intermediate-risk cohort, which was not discernible using either biomarker alone.

CONCLUSIONS AND RELEVANCE: Preoperative Fib and the F-PLR score are independent prognostic factors in OSCC. By integrating both biomarkers, the F-PLR score allowed for more refined prognostic stratification.