Abstract
Background and aim: High levels of peripheral plasma fibrinogen have recently been revealed that related to poor clinical prognosis in various types of malignant tumors. The purpose of this research was to identify the prognostic significance of the preoperative peripheral serum fibrinogen level in patients with penile cell carcinoma.Methods: This retrospective research included 72 penile cancer patients with date about their serum fibrinogen value before surgery who undergone either partial or radical penectomy at The 2nd Hospital of Tianjin Medical University between January 2002 to January 2012. They had a mean follow-up of 30.8 months. To determine the factors that were significant in predicting a patients prognosis, univariate and multivariate analyses were performed according to the Cox proportional hazards regression model.Results: The 5-year cancer specific survival (CSS) rate was 62.4% of patients with preoperative fibrinogen levels below 340 mg/dl and 41.9% for those with higher levels (p = 0.001). Multivariate analysis revealed that the pathological T stage (p < 0.001), tumor grade (p = 0.036), postoperative chemotherapy (p = 0.041), nodal metastasis(p < 0.001), pathological type (p < 0.001) and fibrinogen (p = 0.023) were independent prognostic factors for survival. Patients with low fibrinogen level (<340mg/dl) had significantly longer CSS and the different survival rate were defined using the log-rank test.Conclusions: The high preoperative peripheral serum fibrinogen level was related to poor survival in penile cancer patients. Fibrinogen may serve as a powerful predictor of CSS in penile cancer patients.
Highlights
Penile cancer is a rare but ominous disease, accounting for 0 ~1% of all malignancies in men
Median age was 67 years, and median follow-up was 30.8 months. 27 patients (21.4%) died during the follow-up period. 64 (88.89%) of the tumors were squamous cell carcinoma, 8 (11.11%) of the tumors are other carcinomas. 30 (41.67%) of the tumors stage were pT≥2, 42 (58.33%) pT < 2. 57 (79.12%) of the tumors grade were G3/G4, 15(20.83%) G1/G2, 29 (40.28%) of the tumors were with nodal metastasis, 43(59.72%) without nodal metastasis
Univarate Cox regression analysis showed that - in contrast to advanced age (>60years; hazard ratio (HR) 4.62, 95% CI 0.88-22.4, p = 0.095), raising body mass index (BMI) (>24.3 kg/m2; HR 1.75, 95% CI 0.66-14.25, p = 0.22), high tumor stage(≥pT2; HR 9.75, 95% CI 1.99-25.58, p < 0.001), smoking≥5years, pathological type and even high tumor grade (≥G3; HR 2.84, 95% CI 1.1731.36, p = 0.006),postoperative Chemotherapy(yes; HR 2.08, 95% CI 1.52-64.83, p = 0.032) and nodal metastasis at diagnosis (HR 11.7, 95% CI 4.96-49.91, p < 0.001) were associated with worse cancer specific survival (CSS)
Summary
Penile cancer is a rare but ominous disease, accounting for 0 ~1% of all malignancies in men. According to poor hygiene and economic conditions, its incidence can reach 10% of all malignancies in Asian countries especially india as well as it is higher in Uganda [2]. The main prognostic factor of the penis is the extent of inguinal lymph node involvement [3]. There are no classical molecular biomarkers for clinical practice value of the penis until today. The soluble eptithelial antigen of penile tumor is short of sensitivity in the diagnosis of small size tumor and has poor prognostic significance for survival following operation [4]. High levels of peripheral plasma fibrinogen have recently been revealed that related to poor clinical prognosis in various types of malignant tumors. The purpose of this research was to identify the prognostic significance of the preoperative peripheral serum fibrinogen level in patients with penile cell carcinoma
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