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. 2012 Aug 1:12:330.
doi: 10.1186/1471-2407-12-330.

Tumor response and survival in patients with advanced non-small-cell lung cancer: the predictive value of chemotherapy-induced changes in fibrinogen

Jun Zhao  1 , Mingfang Zhao, Bo Jin, Ping Yu, Xuejun Hu, Yuee Teng, Jingdong Zhang, Ying Luo, Lingyun Zhang, Shuang Zheng, Qiyin Zhou, Heming Li, Yunpeng Liu, Xiujuan Qu
Affiliations

Tumor response and survival in patients with advanced non-small-cell lung cancer: the predictive value of chemotherapy-induced changes in fibrinogen

Jun Zhao et al. BMC Cancer. .

Abstract

Background: Hyperfibrinogenemia is a common problem associated with various carcinomas, and is accompanied by hypercoagulablity. In advanced non-small-cell lung cancer (NSCLC) it remains unclear whether or not chemotherapy-induced changes in fibrinogen level relate to chemotherapeutic response and prognosis. The purposes of this study were to: 1) analyze the association between chemotherapy-induced changes in plasma fibrinogen level and the chemotherapeutic response after the first two courses of standard first-line platinum-based chemotherapy; and 2) evaluate the prognostic significance of the basal plasma fibrinogen level in patients with advanced NSCLC.

Methods: In this retrospective study, the data from 160 patients with advanced NSCLC were collected. The association between the changes in fibrinogen and the response to chemotherapy, or between the pre-and post-chemotherapy fibrinogen levels and patient clinical characteristics, were analyzed using SPSS software. In addition, the prognostic value of pre-chemotherapy fibrinogen levels was assessed.

Results: The median pre-chemotherapy plasma fibrinogen level was 4.4 g/L. Pre-chemotherapy plasma fibrinogen levels correlated significantly with gender (p = 0.041). Post-chemotherapy plasma fibrinogen levels correlated with gender (p = 0.023), age (p = 0.018), ECOG (p = 0.002) and tumor response (p = 0.049). Plasma fibrinogen levels markedly decreased after chemotherapy in 98 (61.25 %) patients with pre-chemotherapy hyperfibrinogenemia (p = 0.008); and in this population there was a significant link between the decrease in fibrinogen level, and initial partial response (PR; p = 0.017) and stable disease (SD; p = 0.031). Univariate and multivariate analysis revealed that higher levels of fibrinogen (≥4.4 g/L) and ECOG 1 were positively associated with shorter overall survival (OS). CEA and CA125 also decreased significantly (p =0.015, p =0.000) in DCR group after chemotherapy.

Conclusions: This study showed that the reduction in plasma fibrinogen levels induced by chemotherapy might be as a promising biomarker as CEA and CA125 for evaluating the efficacy of chemotherapy in advanced NSCLC. In addition, basal plasma fibrinogen levels could be used as an independent prognostic parameter for the OS of patients with advanced NSCLC.

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Figures

Figure 1
Figure 1
Comparison of pre-chemotherapy fibrinogen levels in terms of the disease control rate (DCR) and progression of disease (PD). p = 0.128.
Figure 2
Figure 2
Comparison of post-chemotherapy fibrinogen levels in terms of the disease control rate (DCR) and progression of disease (PD). p = 0.049.
Figure 3
Figure 3
Comparison between pre- and post-chemotherapy fibrinogen levels in 160 patients. Total: p = 0.805, PR: p = 0.432, SD: p = 0.935, PD: p = 0.802.
Figure 4
Figure 4
Comparison between pre- and post-chemotherapy fibrinogen levels in 98 patients with pre-chemotherapy hyperfibrinogenemia. Total: p = 0.008, PR: p = 0.017, SD: p = 0.031, PD: p = 0.689.
Figure 5
Figure 5
Kaplan–Meier curves for progression-free survival (PFS) broken down by median plasma fibrinogen level (4.4 g/L) in 160 patients. p = 0.085.
Figure 6
Figure 6
Kaplan–Meier curves for overall survival (OS) broken down by median plasma fibrinogen level (4.4 g/L) in 160 patients. p = 0.003.
Figure 7
Figure 7
Kaplan–Meier curves for progression-free survival (PFS) broken down by CA125 upper normal limit (35 U/ml) in 125 patients. p = 0.431.
Figure 8
Figure 8
Kaplan–Meier curves for progression-free survival (PFS) broken down by CA125 upper normal limit (35 U/ml) in 125 patients. p = 0.029.
See this image and copyright information in PMC

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