Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2018; 24(44): 5046-5056
Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.5046
Prognostic value of fibrinogen and D-dimer-fibrinogen ratio in resectable gastrointestinal stromal tumors
Hua-Xia Cai, Xu-Qi Li, Shu-Feng Wang
Hua-Xia Cai, Xu-Qi Li, Shu-Feng Wang, Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Hua-Xia Cai, Department of General Surgery, Xi’an 141 Hospital, Yanliang 710089, Shaanxi Province, China
Author contributions: Cai HX and Wang SF designed the study; Cai HX analyzed and interpreted the data and drafted the manuscript; Li XQ and Wang SF revised the controversial parts of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University.
Informed consent statement: All the patients or their legal guardians signed informed consent before the operation. Since this study used anonymous clinical data, patients did not need to give informed consent.
Conflict-of-interest statement: There was no conflict of interest in the present study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author to: Shu-Feng Wang, MD, PhD, Doctor, Full Professor, Surgeon, Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an 710061, Shaanxi province, China.
Telephone: +86-18991232452
Received: August 17, 2018
Peer-review started: August 17, 2018
First decision: October 14, 2018
Revised: October 27, 2018
Accepted: November 9, 2018
Article in press: November 9, 2018
Published online: November 28, 2018

To investigate the prognostic value of preoperative fibrinogen concentration (FIB) and D-dimer-fibrinogen ratio (DFR) in gastrointestinal stromal tumors (GISTs).


The purpose of this study was to retrospectively analyze 170 patients with GISTs who were admitted to our hospital from January 2010 to December 2015. The optimal cutoff values of related parameters were estimated by receiver operating characteristic (ROC) curve analysis. The recurrence free survival (RFS) rate was evaluated using Kaplan-Meier curves. Univariate analysis and multivariate Cox regression models were used to analyze the prognostic factors of GISTs. The relationship between the FIB, D-dimer, DFR, platelet count (PLT), and the clinicopathological features of GISTs was described by the chi-square test or nonparametric rank sum test (Mann-Whitney test).


In ROC analysis, the optimal cutoff values of FIB, D-dimer, DFR, and PLT were 3.24 g/L, 1.24 mg/L, 0.354, and 197.5 (× 109/L), respectively. Univariate analysis and the Kaplan-Meier survival curve showed that FIB, D-dimer, DFR, PLT, National Institutes of Health (NIH) risk category, tumor size, tumor location, and mitotic index were significantly relevant to the 3-year and 5-year survival rate of patients (P < 0.05). Cox multivariate regression analysis illustrated that FIB (RR: 0.108, 95%CI: 0.031-0.373), DFR (RR: 0.319, 95%CI: 0.131-0.777), and NIH risk category (RR: 0.166, 95%CI: 0.047-0.589) were independent prognostic factors of the RFS rate (P < 0. 05). Moreover, FIB, D-dimer, DFR, and PLT were correlated with the clinical features of GISTs.


FIB, D-dimer, DFR, and PLT are all related to the prognosis of GISTs. Moreover, FIB and DFR may be independent risk factors for predicting the prognosis of resectable GISTs.

Keywords: D-dimer, D-dimer-fibrinogen ratio, Prognosis, Fibrinogen, Gastrointestinal stromal tumor

Core tip: For patients with gastrointestinal stromal tumors (GISTs), postoperative recurrence and metastasis are the main factors affecting survival. Moreover, recurrence and metastasis mainly occur in moderate and high-risk patients. Therefore, it is necessary to screen these patients for adjuvant treatment at an early stage. Fibrinogen (FIB) and D-dimer were reported to be associated with the prognosis of many tumors. The purpose of this study was to investigate the value of preoperative FIB, D-dimer, the D-dimer-fibrinogen ratio (DFR), and platelets in the prognosis of GISTs. The results showed that FIB and DFR were independent risk factors for predicting the prognosis of primary resectable GIST.