Research Report
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World J Gastroenterol. Jul 14, 2014; 20(26): 8583-8591
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8583
Prognostic significance of preoperative fibrinogen in patients with colon cancer
Zhen-Qiang Sun, Xiao-Na Han, Hai-Jiang Wang, Yong Tang, Ze-Liang Zhao, Yan-Li Qu, Rui-Wei Xu, Yan-Yan Liu, Xian-Bo Yu
Zhen-Qiang Sun, Hai-Jiang Wang, Ze-Liang Zhao, Xian-Bo Yu, Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Zhen-Qiang Sun, Research Laboratory of Disease Genomics, Cancer Research Institute, Central South University, Changsha 410008, Hunan Province, China
Xiao-Na Han, Yong Tang, Yan-Li Qu, Department of Digestive Oncology, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Rui-Wei Xu, Infection and Statistical Office, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Yan-Yan Liu, Clinical Pharmacy, Tengzhou Central People’s Hospital, Tengzhou 277500, Shandong Province, China
Author contributions: Sun ZQ, Han XN and Wang HJ conceived and designed the study; Sun ZQ wrote the first draft of the manuscript; Zhao ZL and Yu XB assisted with measurements; Tang Y and Xu RW helped analyze the data; Qu YL and Liu YY collected clinicopathological materials and postoperative samples; all authors read and approved the final manuscript.
Supported by The Science and Technology Innovation Fund of Xinjiang Medical University, No. XJC201267
Correspondence to: Hai-Jiang Wang, MD, Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, 789 Suzhou East Street, Urumqi 830011, Xinjiang Uygur Autonomous Region, China. wanghaijiang0129@163.com
Telephone: +86-991-7819106 Fax: +86-991-3654883
Received: November 5, 2013
Revised: February 22, 2014
Accepted: March 12, 2014
Published online: July 14, 2014
Abstract

AIM: To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients.

METHODS: A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1st 2005 to June 1st 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS).

RESULTS: The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P < 0.05). In contrast, there was no significant difference between OS and DFS in stage I patients with low or high fibrinogen levels. Cox regression analysis indicated preoperative fibrinogen levels, TNM stage, mGPS score, CEA, and AFP levels correlated with both OS and DFS.

CONCLUSION: Preoperative fibrinogen levels can serve as an independent prognostic marker to evaluate patient response to colon cancer treatment.

Keywords: Fibrinogen, Colon cancer, Clinicopathological parameters, Relationship, Prognosis

Core tip: Inflammatory cytokines have been implicated in the development of several malignancies, including colon cancer. Specifically, fibrinogen has been correlated with some clinicopathological factors of cancer. However, the prognostic value of fibrinogen measurements remains unclear, particularly in colon cancer patients. In this study, preoperative fibrinogen levels were correlated with a poor prognosis in a cohort of colon cancer patients. These data suggest that preoperative fibrinogen levels can serve as an independent prognostic factor for colon cancer patients following radical surgery.