# Combined fibrinogen concentration and neutrophil-to-lymphocyte ratio, an integrative model of the inflammatory response and coagulation cascades, for predicting prognosis in patients with upper tract urothelial carcinoma

## TL;DR

This study shows that combining fibrinogen levels and neutrophil-to-lymphocyte ratio improves prognosis prediction in upper tract urothelial carcinoma patients.

## Contribution

The novel F-NLR score integrates inflammation and coagulation markers to enhance survival prediction in UTUC patients.

## Key findings

- F-NLR score is an independent risk factor for overall, cancer-specific, and progression-free survival.
- F-NLR-based nomograms improve predictive accuracy compared to existing models.
- Cut-off values for NLR and fibrinogen were identified using ROC curve analysis.

## Abstract

Inflammation and coagulation cascades are closely correlated with cancer occurrence and progression. This study investigated the prognostic value of the combination of plasma fibrinogen level and neutrophil-to-lymphocyte ratio (F-NLR) in patients with upper tract urothelial carcinoma (UTUC). The predictive ability of the F-NLR for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) was initially established and then further validated in patients who underwent radical nephroureterectomy (RNU) for UTUC. As a result, patients were divided into three groups following the establishment of cut-off values for the neutrophil-to-lymphocyte ratio (NLR) (≥2.53 vs <2.53) and fibrinogen (≥4.55 vs <4.55) through receiver operating characteristic (ROC) curve analysis: F-NLR score 0 (low fibrinogen and low NLR), 2 (high fibrinogen and high NLR), or 1 (remaining patients). The F-NLR score was then identified as an independent risk factor for OS, CSS, and PFS (all P value <0.05) by multivariate regression analysis in both the training and validation cohorts. In addition, F-NLR-based nomograms for OS, CSS, and PFS were developed and evaluated using the concordance index (C-index) and calibration curves. The integration of the F-NLR into existing nomograms improved predictive accuracy compared to the use of nomograms without the F-NLR score. This suggests that the addition of F-NLR is beneficial for enhancing the accuracy of prognosis prediction in patients with UTUC. The F-NLR score may serve as a powerful predictor for patients with UTUC.