Abstract
This study investigated the correlation of preoperative plasma fibrinogen level with distant metastasis and prognosis in esophageal squamous cell carcinoma (ESCC). A total of 255 patients with ESCC who underwent surgery in Zhejiang cancer hospital (Hangzhou, China), between October 2006 and December 2009, were evaluated in this retrospective study. Population controls were selected from a pool of cancer-free subjects in the same region. Each patient and cancer-free people provided 3-mL pretreatment blood. Plasma fibrinogen level was measured by the Clauss method. The effects of hyperfibrinogenemia on locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS) were assessed using Kaplan-Meier analysis. Independent prognostic factors were identified in the multivariate Cox analysis. The proportion of hyperfibrinogenemia was higher in ESCC patients than those in controls (40.4% vs 13.6%). Subjects with hyperfibrinogenemia had a significantly higher risk of ESCC than those with normal plasma fibrinogen level (adjust OR = 4.61; 95% CI = 3.02-7.01, P < 0.001) after adjusted for age, sex and smoking status. The Kaplan-Meier curves showed that patients with hyperfibrinogenemia had worse DMFS, RFS and OS (P < 0.001). Tumor length, lymph node metastasis and plasma fibrinogen level were independent prognostic factors of ESCC (P < 0.05). Increased plasma fibrinogen level was significantly associated with elevated risk of ESCC. Preoperative plasma fibrinogen level was a predictor of distant metastasis and independently associated with prognosis of patients with ESCC.
Highlights
Esophageal cancer is one of the common malignant neoplasms, with very poor outcome
The proportion of hyperfibrinogenemia was higher in esophageal squamous cell carcinoma (ESCC) patients than those in controls (40.4% vs 13.6%)
The proportion of hyperfibrinogenemia was higher in ESCC patients than those in healthy controls (40.4% Vs 13.6%)
Summary
Esophageal cancer is one of the common malignant neoplasms, with very poor outcome. Despite the great progress of in the management of operable ESCC, the prognosis for patients with distant organ metastasis is still unsatisfactory [2]. The American Joint Committee on Cancer (AJCC) staging system is commonly used to predict prognosis for patients with ESCC. Some patients with similar clinical stage have remarkably different survival prognosis. In this way, heterogeneity of protein expression profiles may play a very important role in the development of ESCC [4]. The ability to predict patients with high risk of distant organ metastasis would help guide adjuvant chemotherapy or radiotherapy treatment during the decision-making process. Most of these markers had not been proven to be sufficiently effective [5]
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