Plasma fibrinogen levels are correlated with postoperative distant metastasis and prognosis in esophageal squamous cell carcinoma

Abstract

This study investigated the correlation of preoperative plasma fibrinogen level with distant metastasis and prognosis in esophageal squamous cell carcinoma (ESCC). A total of 255 patients with ESCC who underwent surgery in Zhejiang cancer hospital (Hangzhou, China), between October 2006 and December 2009, were evaluated in this retrospective study. Population controls were selected from a pool of cancer-free subjects in the same region. Each patient and cancer-free people provided 3-mL pretreatment blood. Plasma fibrinogen level was measured by the Clauss method. The effects of hyperfibrinogenemia on locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS) were assessed using Kaplan-Meier analysis. Independent prognostic factors were identified in the multivariate Cox analysis. The proportion of hyperfibrinogenemia was higher in ESCC patients than those in controls (40.4% vs 13.6%). Subjects with hyperfibrinogenemia had a significantly higher risk of ESCC than those with normal plasma fibrinogen level (adjust OR = 4.61; 95% CI = 3.02-7.01, P < 0.001) after adjusted for age, sex and smoking status. The Kaplan-Meier curves showed that patients with hyperfibrinogenemia had worse DMFS, RFS and OS (P < 0.001). Tumor length, lymph node metastasis and plasma fibrinogen level were independent prognostic factors of ESCC (P < 0.05). Increased plasma fibrinogen level was significantly associated with elevated risk of ESCC. Preoperative plasma fibrinogen level was a predictor of distant metastasis and independently associated with prognosis of patients with ESCC.

Keywords: esophageal squamous cell carcinoma; fibrinogen; metastasis; prognosis.

Figure 1. Plasma fibrinogen level in ESCC patients (n = 255) was significantly higher than that of healthy controls (n = 273) (3.89 ± 1.02 g/L vs 3.21 ± 0.84 g/L, P < 0.001)

Figure 2

Survival curves of A. distant metastasis free survival (DMFS) subdivided by plasma fibrinogen level in ESCC patients (n = 255), B. Relapse-free survival (RFS) subdivided by plasma fibrinogen level in ESCC patients (n = 255), C. Overall survival (OS) subdivided by plasma fibrinogen level in ESCC patients (n = 255), D. Locoregional relapse-free survival (LRFS) subdivided by plasma fibrinogen level in ESCC patients (n = 255).

Figure 3

Survival curves of A. DMFS B. RFS C. OS subdivided by plasma fibrinogen level in ESCC patients without adjuvant postoperative chemotherapy (n = 200), D. DMFS E. RFS F. OS subdivided by plasma fibrinogen level in ESCC patients with adjuvant postoperative chemotherapy (n = 55).

Figure 4

Survival curves of A. DMFS B. RFS C. OS subdivided by plasma fibrinogen level in ESCC patients without adjuvant postoperative radiotherapy (n = 199), D. DMFS E. RFS F. OS subdivided by plasma fibrinogen level in ESCC patients with adjuvant postoperative radiotherapy (n = 56).

Figure 5

Survival curves of A. DMFS B. RFS C. OS subdivided by plasma fibrinogen level in T_1–2 stage ESCC patients (n = 85), D. DMFS E. RFS F. OS subdivided by plasma fibrinogen level in T_3–4 stage ESCC patients (n = 170).

Figure 6

Survival curves of A. DMFS B. RFS C. OS subdivided by plasma fibrinogen level in ESCC patients without lymph node metastasis (n = 127), D. DMFS E. RFS F. OS subdivided by plasma fibrinogen level in ESCC patients with lymph node metastasis (n = 128).