Preoperative Albumin-to-Fibrinogen Ratio as a Prognostic Biomarker in Bladder Cancer: A Systematic Review and Meta-Analysis

The Albumin-To-Fibrinogen Ratio (AFR) reflects both nutritional status and systemic inflammation, which are critical determinants of cancer prognosis. This systematic review aimed to evaluate the prognostic value of preoperative AFR in patients with bladder cancer.

This review was registered in PROSPERO (CRD420251110236). PubMed, the Cochrane Library, and EBSCOhost were searched up to July 2025 for studies reporting preoperative AFR (or its reciprocal, FAR) and survival outcomes in patients with histologically confirmed bladder cancer. Hazard Ratios (HRs) for Overall Survival (OS) were pooled using Review Manager and STATA, while progression- and recurrence-related outcomes were synthesized narratively because of differences in endpoint definitions.

Four studies involving 1,381 patients were included. Preoperative AFR was not significantly associated with OS (HR 1.41, 95% CI: 0.51–3.94, p = 0.51). Individual studies generally suggested an association between lower AFR and unfavorable recurrence or progression outcomes.

AFR may reflect the combined effects of systemic inflammation and nutritional status; however, differences in disease stage, treatment modality, and cut-off values limit interpretation of the pooled results.

Lower preoperative AFR was associated with unfavorable oncological outcomes in individual studies; however, the pooled analysis showed no significant association with overall survival, with substantial heterogeneity among studies. As a routinely available and inexpensive marker, AFR may serve as a complementary prognostic biomarker in bladder cancer, but current evidence is insufficient to establish its independent prognostic value. Standardized cut-off values and prospective multicenter validation are warranted.