Clinical and prognostic significance of plasma fibrinogen in lung cancer

Abstract

Objectives: Hyperfibrinogenemia is a common problem associated with various carcinomas. The recent studies have shown that high plasma fibrinogen concentration is associated with invasion, growth and metastases of cancer. Furthermore, the recent studies focus on the prognostic significance of fibrinogen in the patients with advanced NSCLC (stage IIIB -IV). However, the prognostic significance of the plasma fibrinogen levels in early stage NSCLC patients (stage I -IIIA) still remains unclear. In addition, it remains unclear whether or not chemotherapy-induced changes in fibrinogen level relate to the prognosis. The aims of this study were to 1) further explore the relationship between the plasma fibrinogen concentration and the stage and metastases of lung cancer 2) evaluate the prognostic significance of the basal plasma fibrinogen level in patients with lung cancer 3) explore the prognostic value of the change in fibrinogen levels between pre and post-chemotherapy. Methods: In this retrospective study, the data from 370 patients with lung cancer were enrolled into this study. The plasma fibrinogen levels were compared with the clinical and prognostic significance of lung cancer. The association between the plasma fibrinogen level and clinical-prognostic characteristics were analyzed using SPSS 17.0 software. Results: 1) The median pre-treatment plasma fibrinogen levels were 4.20g/L. Pre-treatment plasma fibrinogen levels correlated significantly with gender (p  0.013). A higher plasma fibrinogen concentration was associated with squamous cell carcinoma versus adenocarcinoma (4.831.50 g/L versus 4.151.30 g/L; P0.001), there was a significant association between plasma fibrinogen level and metastases of lung cancer, pointing a higher plasma fibrinogen level in lymph nodes or distant organ metastases (p  0.001). 2) Patients with low plasma fibrinogen concentration demonstrates higher overall survival compared with those with high plasma fibrinogen concentration (median, 19 months versus 35 months; P 0.001). In addition, a similar result was observed in 194 early stage NSCLC (stage I -IIIA) (P 0.001). Univariate and multivariate analysis revealed that higher levels of fibrinogen (FIB4.20 g/L), age, distant metastases and pathological types were positively associated with shorter overall survival (OS). 3) In addition, there was a significant link between the elevation by more than 15% in the plasma fibrinogen level after receiving short-term chemotherapy and shorter overall survival (OS). Conclusion: 1) This study shows high plasma fibrinogen concentration is associated with lymph nodes or distant organ metastases in lung cancer. 2) Furthermore, our results indicate a significant relevance between high pre-treatment plasma fibrinogen concentration and poor prognosis in patients with lung cancer. 3) In addition, we find that the patients with a low plasma fibrinogen level will have a shorter OS if the plasma fibrinogen level increases significantly after receiving short-term chemotherapy. Interestingly, we also find that the patients with a high plasma fibrinogen level will have a longer OS if the plasma fibrinogen level decreases significantly after receiving short-term chemotherapy, which indicate the change of the plasma fibrinogen level after receiving short-term chemotherapy may be used as an independent prognostic factor.