Prognostic value of peripheral blood fibrinogen-to-albumin ratio in pancreatic cancer patients: a systematic review and meta-analysis.

[BACKGROUND] Pancreatic cancer (PC) is a highly lethal malignancy with poor prognosis, largely due to late diagnosis and limited therapeutic efficacy. Identifying accessible and reliable prognostic biomarkers is essential for individualized patient management. The fibrinogen-to-albumin ratio (FAR) has emerged as a potential indicator reflecting systemic inflammation and nutritional status.

[METHODS] We performed a systematic review and meta-analysis of studies assessing FAR in PC patients. Databases including PubMed, Scopus, EMBASE, and the Cochrane Library were searched up to September 2025. Eligible studies reported hazard ratios (HRs) for overall survival (OS) or progression-free survival (PFS). Pooled analyses, subgroup evaluations, sensitivity tests, and publication bias assessments were conducted using standard meta-analytic techniques.

[RESULTS] Six retrospective studies encompassing 1,295 patients were included. High FAR was significantly associated with worse OS (HR = 2.26; 95% CI: 1.73–2.96;  < 0.001) and shorter PFS (HR = 1.88; 95% CI: 1.34–2.66;  < 0.001). Subgroup analyses confirmed the prognostic value of FAR across different treatment modalities and cut-off thresholds. Sensitivity analyses and publication bias tests supported the robustness of these findings.

[CONCLUSIONS] High FAR is a simple, cost-effective, and reproducible biomarker predicting poor survival in PC, integrating tumor-related inflammation and host nutritional status. FAR may aid in risk stratification and individualized management, though prospective, multicenter studies are needed to validate its clinical utility and clarify underlying mechanisms.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12885-026-15840-7.