Pretreatment plasma fibrinogen level as a prognostic biomarker for patients with lung cancer

Abstract

Many researchers have shown that pretreatment plasma fibrinogen levels are closely correlated with the prognosis of patients with lung cancer (LC). In this study, we thus performed a meta-analysis to systematically assess the prognostic value of pretreatment plasma fibrinogen levels in LC patients. A computerized systematic search in PubMed, EMBASE, Web of Science and China National Knowledge Infrastructure (CNKI) was performed up to March 15, 2018. Studies with available data on the prognostic value of plasma fibrinogen in LC patients were eligible for inclusion. The pooled hazard ratios (HRs) and odd ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the correlation between pretreatment plasma fibrinogen levels and prognosis as well as clinicopathological characteristics. A total of 17 studies with 6,460 LC patients were included in this meta-analysis. A higher pretreatment plasma fibrinogen level was significantly associated with worse overall survival (OS) (HR: 1.57; 95% CI: 1.39-1.77; p=0.001), disease-free survival (DFS) (HR: 1.53; 95% CI: 1.33-1.76; p=0.003), and progression-free survival (PFS) (HR: 3.14; 95% CI: 2.15-4.59; p<0.001). Furthermore, our subgroup and sensitivity analyses demonstrated that the pooled HR for OS was robust and reliable. In addition, we also found that a higher fibrinogen level predicted advanced TNM stage (III-IV) (OR=2.18, 95% CI: 1.79-2.66; p<0.001) and a higher incidence of lymph node metastasis (OR=1.74, 95% CI: 1.44-2.10; p=0.02). Our study suggested that higher pretreatment plasma fibrinogen levels predict worse prognoses in LC patients.

Figure 1. Flow diagram of the literature identification process.

Figure 2. Forest plot of the hazard ratio (HR) for the association between the plasma fibrinogen level and overall survival (OS) in patients with lung cancer.

Figure 3. Forest plot of the hazard ratio (HR) for the association between the plasma fibrinogen level and disease-free survival (DFS) in patients with lung cancer.

Figure 4. Forest plot of the hazard ratio (HR) for the association between the plasma fibrinogen level and progression-free survival (PFS) in patients with lung cancer.

Figure 5. Forest plot of the odds ratios (ORs) for the association of the plasma fibrinogen level with TNM stage (A), lymph node metastasis (B), sex (C) and age (D).

Figure 6. Subgroup analysis of exploring the possible sources of heterogeneity for the pooled HR for OS.

Figure 7. Sensitivity analyses of assessing the robustness of the pooled HR for OS.

Figure 8. Begg’s funnel plot of evaluating the publication bias for OS (A). Adjusted Begg’s funnel plot from the trim-and-fill method for assessing the publication bias for OS (B).