Hyperfibrinogenemia predicts poor prognosis in patients with advanced biliary tract cancer

Abstract

Hyperfibrinogenemia reportedly predicts poor prognosis in several cancers but has not been reviewed for biliary tract cancer (BTC). The aim of the present study was to evaluate associations between baseline plasma fibrinogen concentrations, clinicopathological characteristics, and survival parameters in patients with BTC. Data for 127 patients with BTC diagnosed at the Zhongshan Affiliated Hospital of Dalian University (Liaoning, China) from January 2011 to December 2014 were retrospectively evaluated. Associations between baseline fibrinogen concentrations, selected clinicopathological characteristics, and the prognostic value were examined using SPSS software. Data for 37 patients (29.1 % of study cohort) who had undergone curative intent surgery and 90 (70.9 %) with advanced biliary tract cancer (ABTC) were analyzed. The mean plasma fibrinogen concentration 4.0 ± 0.9 g/L for the entire cohort. The percentages with hyperfibrinogenemia (>4 g/L) were 45.7, 37.8, and 48.9 % overall and in the surgical and ABTC groups, respectively. Hyperfibrinogenemia was associated with performance status (PS) and neutrophil/lymphocyte ratio in the entire cohort but not with other relevant clinicopathological factors. Log-rank test indicated that baseline hyperfibrinogenemia was associated with decreased progression-free survival (PFS) and overall survival (OS) for patients with unresectable ABTC (P > 0.05). Multivariate analysis showed that poor PS and baseline hyperfibrinogenemia were independently associated with worse survival (HR: 1.39, 95 % CI: 1.02-1.90, P = 0.04; HR: 1.75.95 %, 95 % CI: 1.01-3.01, P = 0.04, respectively). Baseline hyperfibrinogenemia is an independent predictor of poor prognosis in patients with ABTC. Baseline plasma fibrinogen concentrations may be a readily available and inexpensive prognostic biomarker in patients with ABTC; this needs further validation in large prospective clinical trials.

Elevated serum plasma fibrinogen is associated with advanced tumor stage and poor survival in hepatocellular carcinoma patients

“…Our results are in accordance with previous studies of other types of tumors. [9,24] The mechanism underlying this association may be the binding of fibrinogen to members of the transforming growth factor-B, vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor gene families, thereby leading to the inhibition of apoptosis, angiogenesis, and metastasis and promotion of tumor cell proliferation. [8,25] Platelet-fibrin microthrombi appear to act as a physical barrier, preventing contact between natural killer cells and tumor cells.…”

“…Recent studies have provided strong evidence that plasma fibrinogen is associated with tumor progression and poor prognosis in lung cancer, [4] breast cancer, [5] gastric cancer, [6] ovarian cancer, [7] oral and oropharyngeal cancer, [8] biliary tract cancer, [9] and penile cancer [10] patients. Fibrinogen is a 340-kDa glycoprotein that is synthesized in the liver and converted into fibrin by active thrombin.…”

Coagulation and fibrinolysis in gastric cancer

“…[98][99][100] Hyperfibrinogenemia is increasingly recognized as an important risk factor influencing cancer development and outcome, associated with poor prognosis in various cancers (e.g., ovarian, biliary, esophageal, and pancreatic). 26,[101][102][103][104][105][106] Globally, an elevated content of FBG in plasma before treatment significantly correlates with decreased survival in patients with solid tumors. 107 Recently, in rectal cancer tissues, Repetto et al 108 identified FBG ␤ chain as a marker for identification of poor responders before therapy.…”

Prognostic value of combined preoperative fibrinogen and neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma after liver transplantation

“…So the fibrinogen may take part in the adhesive interaction among tumor cells or endothelial cells, and lead to hematogenous metastasis [30, 31]. Elevated levels of plasma fibrinogen are reported to be an useful prognostic predictor for several types of human cancers [15–19]. So we aim to clarify the prognostic ability of fibrinogen in HCC patients after liver transplantation.…”

“…It reflects inflammatory response of the host to cancer as well as the systemic inflammation mediated by tumor [14]. Previous studies have shown that preoperative hyperfibrinogenemia and NLR were associated with the progression and poor prognosis of several cancers, such as colorectal [15], gastric [16], pancreatic [17], and lung cancer [18], biliary tract cancer [19], HCC [20]. However, the relationship between plasma Fib concentration and prognosis of HCC patients with after liver transplantation is not very clear, especially the prognostic value of Fib in combination with NLR has not been determined.…”