BACKGROUND: Gallbladder cancer (GBC) is known for its poor prognosis and challenging management. The preoperative fibrinogen to albumin ratio (FAR) has been proposed as a potential prognostic marker for predicting postoperative outcomes in GBC patients, but its efficacy and prognostic value remain underexplored. AIM: To evaluate the prognostic value of preoperative FAR in GBC outcomes. METHODS: This retrospective cohort study included 66 patients who underwent curative surgery for GBC at our institution from January 2018 to January 2022. Preoperative FAR values were obtained within one week prior to surgery. Patients were followed through outpatient visits or telephone interviews, with overall survival (OS) as the primary endpoint. Statistical analyses, including receiver operating characteristic curve analysis and Kaplan-Meier survival estimates, were performed using SPSS software (version 27.0). RESULTS: The cohort consisted of 36 male and 30 female patients, with a mean age of 61.81 ± 8.58 years. The optimal FAR cut-off value was determined to be 0.088, with an area under the receiver operating characteristic curve of 0.7899, sensitivity of 68.96%, and specificity of 80.01%. Patients with FAR ≤ 0.088 showed significantly better survival rates (1-year: 60.5%, 2-year: 52.6%, 3-year: 25.9%) and a median OS of 25.6 months (95% confidence interval: 18.8-30.5 months), compared to those with FAR >
0.088 who had a median OS of 10.8 months (95% confidence interval: 6.3-12.9 months). CONCLUSION: Lower preoperative FAR is associated with longer OS in GBC patients, confirming its potential as a valuable prognostic indicator for improving outcome predictions and guiding patient management strategies in gallbladder cancer.