Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

Abstract

PurposeEffective prognostic factors for patients with stage IVA/B nasopharyngeal carcinoma (NPC) who are susceptible to distant metastases are limited. We aim to investigate the prognostic value of pretreatment plasma fibrinogen (FIB) level and Epstein–Barr virus DNA (EBV-DNA) load in these patients in the era of intensity-modulated radiotherapy (IMRT).ResultsThe 5-year DSS, DFS and DMFS rates of the entire cohort were 72.7%, 66.8%, 80.0%, respectively. High FIB level was identified as a negative prognostic factor for survival: the 5-year DSS, DFS and DMFS rates for patients with high FIB (> 4.0 g/L) and normal FIB (≤ 4.0 g/L) were 60.3% vs. 76.0%, 56.0% vs. 69.9%, and 59.4% vs. 85.5%, respectively (all P < 0.001). Subgroup analysis demonstrated that DSS, DFS and DMFS decreased as FIB gradually increased, even within the normal range. The risk of distant metastasis in patients with high FIB was over 3-fold than patients with normal FIB. EBV-DNA was not an independent prognostic factor for any survival outcomes in multivariate analysis.ConclusionHigh pretreatment FIB level shows superior prognostic value than EBV-DNA load for stage IVA/B NPC patients in the era of IMRT.Materials and MethodsA total of 755 patients with newly-diagnosed stage IVA/B NPC treated with definitive IMRT between January 2007 and December 2011 were enrolled. Plasma FIB and EBV-DNA were measured before treatment. Disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method; differences were compared using the log-rank test.

Hemastatic biomarkers as prognostic factors in locoregionally advanced nasopharyngeal carcinoma treated with nimotuzumab plus chemoradiotherapy

“…Several studies have confirmed that an increase in platelet number and FIB level were correlated with poor prognosis in many solid tumor types [24][25][26][27][28][29]. A similar conclusion was also drawn in NPC [5][6][30][31][32][33].…”

Plasma Fibrinogen Correlates with Metastasis and is Associated with Prognosis in Human Nasopharyngeal Carcinoma

“…Previous studies have demonstrated similar associations between fibrinogen and prognosis in other tumor types; however, there have been few studies to assess the prognostic value of pre-treatment plasma fibrinogen in NPC. Recently, Lan et al 21 reported pre-treatment plasma fibrinogen and pre-treatment plasma EBV DNA had clinical significance in patients with stage IVA/B NPC treated with IMRT: higher pre-treatment plasma fibrinogen was associated with poorer disease-specific survival (DSS), disease-free survival (DFS) and DMFS. Moreover, high pre-treatment plasma fibrinogen had superior prognostic value to the pre-treatment plasma EBV DNA load 21 , even though EBV DNA has been established as one of the most significant prognostic factors in NPC 22 .…”

Prognostic stratification of patients with nasopharyngeal carcinoma based on tumor immune microenvironment

“…3,4 Therefore, surgery is generally not the first line of treatment in most cases. [9][10][11][12] Because programmed death-ligand 1 (PD-L1) is frequently overexpressed in many types of human cancers, 13 the PD1/ PD-L1 axis is thought to be one of the mechanisms by which cancer cells escape immune surveillance. [5][6][7][8] Recently, various clinicopathological factors have been reported to predict the prognosis in patients with NPC.…”

“…[5][6][7][8] Recently, various clinicopathological factors have been reported to predict the prognosis in patients with NPC. [9][10][11][12] Because programmed death-ligand 1 (PD-L1) is frequently overexpressed in many types of human cancers, 13 the PD1/ PD-L1 axis is thought to be one of the mechanisms by which cancer cells escape immune surveillance. 13 Patients with NPC who have a high PD-L1 expression have been shown to have a better prognosis than those with a low PD-L1 expression.…”