Prognostic role of preoperative plasma fibrinogen-to-albumin ratio in urological carcinomas: a systematic review and meta-analysis

BACKGROUND: Growing evidence indicates that the pre-operative ratio of fibrinogen to albumin (FAR/AFR) can act as a prognostic predictor for different kinds of cancer. Although a previous meta-analysis briefly involved urological malignancies, it only incorporated one study for bladder cancer (BC) and one for renal cell carcinoma (RCC) with limited data. To date, a comprehensive and systematic quantitative assessment of plasma FAR/AFR as a prognostic indicator in urological cancers remains lacking. OBJECTIVE: This meta-analysis intended to comprehensively investigate the prognostic significance of plasma FAR/AFR in individuals with urological malignancies. METHODS: A thorough search of the PubMed, Embase, and Web of Science databases was carried out up to March 2026, leading to the incorporation of 6 studies for this meta-analysis. The research computed hazard ratios (HRs) together with their 95% confidence intervals (CIs) to evaluate disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). RESULTS: The study included a total of 1,603 participants. Patients suffering from RCC and BC who showed an increase in pre-operation FAR or a decrease in pre-operation AFR had poorer overall survival (combined HR = 2.36, 95% CI = 1.92-2.91; p < 0.001), cancer-specific survival (combined HR = 2.27, 95% CI = 1.77-2.91; p = 0.003), and disease-free survival (combined HR = 2.32, 95% CI = 1.62-3.31; p < 0.001).Analysis based on cancer type showed that an increased pre-surgical FAR or a decreased pre-surgical AFR was associated with poorer overall survival in RCC) (combined HR = 3.19, 95% CI = 1.84-5.54, p < 0.001) and also in BC (combined HR = 2.25, 95% CI = 1.80-2.81, p < 0.001). CONCLUSIONS: Increased FAR or decreased AFR act as independent markers of unfavorable survival prognosis in patients with RCC and BC.