The Fibrinogen-to-Albumin Ratio (FAR) Predicts Prognosis in Hepatocellular Carcinoma Patients After Liver Transplantation: Development and Validation of a Novel Nomogram

Xiao-Yong Ye,* Ai-Xin Leng,* Qiang He, Zhili Ji, Jun Ma Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jun Ma; Zhili Ji, Email [email protected]; [email protected]: Hepatocellular carcinoma (HCC) is a common liver tumor. The fibrinogen-albumin ratio (FAR) combined inflammation and nutrition, may have value in the prognosis assessment of HCC patients undergoing liver transplantation.Materials and Methods: A total of 239 patients were enrolled in the study and randomly divided into a training set and a validation set in a 7:3 ratio. The optimal cut-off value of FAR was determined by Maximally Selected Rank Statistics, and univariate and multivariate Cox regression analyses were conducted to evaluate the predictive value of FAR for overall survival (OS) and disease-free survival (DFS) in HCC patients after liver transplantation.Results: FAR had a non-linear relationship with OS and DFS, with the optimal cut-off value being 0.0623. Patients in the high FAR group had significantly poorer prognosis (P < 0.05). Multivariate Cox regression analysis further demonstrated that microvascular invasion and FAR ≥ 0.0623 were independent risk factors for OS and DFS. The prognostic prediction model based on FAR and microvascular invasion had good predictive performance and clinical utility.Conclusion: This preoperative FAR is an independent prognostic factor for OS and DFS in HCC patients undergoing liver transplantation. The Nomogram model based on FAR has good predictive performance.Keywords: liver transplantation, hepatocellular carcinoma, fibrinogen‑to‑albumin ratio, prognosis, overall survival