High level of preoperative serum fibrinogen is a predictor of poor prognosis in patients with esophageal squamous cell carcinoma

Abstract

Abstract Objective This study aimed to elucidate the association between the level of preoperative serum fibrinogen (PSF) and the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Methods From January 2010 to December 2016, all patients diagnosed with ESCC who underwent surgery in Qingdao Municipal Hospital were analyzed retrospectively. Moreover, the fibrinogen levels of all patients were assessed before surgery, and hyperfibrinogenemia was diagnosed when the fibrinogen level was ≥4.0 g/L. The impact of PSF on disease-free survival (DFS) and overall survival (OS) was analyzed using the log-rank method and Cox proportional hazards regression model. P value less than 0.05 was considered statistically significant. Results A total of 336 patients were finally analyzed, and approximately 102 patients (30.36%) were diagnosed with hyperfibrinogenemia before surgery. Hyperfibrinogenemia was associated with older age (≥ 70 years) (P = 0.012), advanced pathological T stage (P = 0.003), and lymph node involvement (P = 0.024). Univariate analysis showed that patients with hyperfibrinogenemia had shorter DFS (1.96 years vs. 3.64 years, P = 0.001) and OS (2.27 years vs. 4.15 years, P < 0.001) than patients without hyperfibrinogenemia. Multivariate analysis confirmed that PSF was an independent factor affecting DFS (risk ratio [RR]: 1.35, 95% confidence interval [CI]: 1.02-1.79, P = 0.038) and OS (RR: 1.37, 95% CI: 1.03-1.83, P = 0.034) in patients with ESCC. Conclusion For patients with operable ESCC, hyperfibrinogenemia had poor prognosis. Moreover, PSF is an independent prognostic factor for operable ESCC.