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Wu X, Yu X, Chen C, Chen C, Wang Y, Su D, Zhu L. Fibrinogen and tumors. Front Oncol 2024; 14:1393599. [PMID: 38779081 PMCID: PMC11109443 DOI: 10.3389/fonc.2024.1393599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Elevated plasma fibrinogen (Fg) levels consistently correlate with an unfavorable prognosis in various tumor patient cohorts. Within the tumor microenvironment, aberrant deposition and expression of Fg have been consistently observed, interacting with multiple cellular receptors and thereby accentuating its role as a regulator of inflammatory processes. Specifically, Fg serves to stimulate and recruit immune cells and pro-inflammatory cytokines, thereby contributing to the promotion of tumor progression. Additionally, Fg and its fragments exhibit dichotomous effects on tumor angiogenesis. Notably, Fg also facilitates tumor migration through both platelet-dependent and platelet-independent mechanisms. Recent studies have illuminated several tumor-related signaling pathways influenced by Fg. This review provides a comprehensive summary of the intricate involvement of Fg in tumor biology, elucidating its multifaceted role and the underlying mechanisms.
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Affiliation(s)
- Xinyuan Wu
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaomin Yu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cheng Chen
- Department of Hematology, Wenzhou Key Laboratory of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenlu Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuxin Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dongyan Su
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liqing Zhu
- Department of Clinical Laboratory, Peking University Cancer Hospital and Institute, Beijing, China
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Peschek LS, Hobusch GM, Funovics PT, Willegger M, Schmid MP, Amann G, Lamm W, Brodowicz T, Ay C, Windhager R, Panotopoulos J. High fibrinogen levels are associated with poor survival in patients with liposarcoma. Sci Rep 2023; 13:8608. [PMID: 37244918 DOI: 10.1038/s41598-023-31527-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/14/2023] [Indexed: 05/29/2023] Open
Abstract
The aim of this study was to evaluate whether (preoperative) plasma levels of fibrinogen, an essential clotting and acute phase protein, are associated with the prognosis of patients with a liposarcoma, a subtype of sarcoma derived from adipose tissue. We performed a retrospective cohort study of 158 patients with liposarcoma treated at the Department of Orthopaedics of the Medical University of Vienna in Austria from May 1994 to October 2021. Kaplan-Meier curves as well as uni- and multivariable Cox proportional hazard models were performed to evaluate the association between fibrinogen levels and overall survival. Elevated fibrinogen was associated with adverse overall survival in cause specific hazards analysis of mortality (hazard ratio [HR] per 10 mg/dL increase: 1.04; 95% CI 1.02-1.06; p < 0.001). This association prevailed in multivariable analysis after adjustment for AJCC tumor stage (HR 1.03; 95% CI 1.01-1.05; p = 0.013). Increasing levels of fibrinogen, a routinely available and inexpensive parameter, predicts the risk of mortality in patients with liposarcoma.
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Affiliation(s)
- L S Peschek
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - P T Funovics
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Willegger
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - G Amann
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - W Lamm
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Th Brodowicz
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - C Ay
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - R Windhager
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - J Panotopoulos
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Song Y, Tian J, Yang L, Zhang Y, Dong Z, Ding H, Wang J, Wang Y, Wang H, Wang Z. Prognostic value of preoperative platelet-related parameters and plasma fibrinogen in patients with non-muscle invasive bladder cancer after transurethral resection of bladder tumor. Future Oncol 2022; 18:2933-2942. [PMID: 35880441 DOI: 10.2217/fon-2022-0223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Aim: To investigate the prognostic value of preoperative mean platelet volume (MPV), MPV/lymphocyte ratio (MPVLR), MPV/platelet count ratio and plasma fibrinogen in patients with non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). Methods: A total of 371 patients who underwent TURBT were enrolled. The main end points were disease-free survival (DFS) and overall survival (OS). Results: MPVLR, tumor size, tumor number and pathological grade were independent risk factors for postoperative DFS. Age and pathological grade were independent risk factors for postoperative OS. Conclusion: MPVLR is an independent risk factor for DFS in NMIBC patients and could be used as a parameter to predict postoperative tumor recurrence in patients after TURBT.
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Affiliation(s)
- Yutong Song
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Junqiang Tian
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Li Yang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Yunxin Zhang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Zhilong Dong
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Hui Ding
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Juan Wang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Yuhan Wang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
| | - Hanzhang Wang
- Department of Urology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephro-urology, Lanzhou University, Lanzhou, China
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Huang Y, Zhu Q, Xue L, Zhu X, Chen Y, Wu M. Machine Learning-Assisted Ensemble Analysis for the Prediction of Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer. Front Oncol 2022; 12:817250. [PMID: 35425697 PMCID: PMC9001844 DOI: 10.3389/fonc.2022.817250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical benefit of neoadjuvant chemotherapy (NACT) before concurrent chemoradiotherapy (CCRT) vs. adjuvant chemotherapy after CCRT is debated. Non-response to platinum-based NACT is a major contributor to poor prognosis, but there is currently no reliable method for predicting the response to NACT (rNACT) in patients with locally advanced cervical cancer (LACC). In this study we developed a machine learning (ML)-assisted model to accurately predict rNACT. We retrospectively analyzed data on 636 patients diagnosed with stage IB2 to IIA2 cervical cancer at our hospital between January 1, 2010 and December 1, 2020. Five ML-assisted models were developed from candidate clinical features using 2-step estimation methods. Receiver operating characteristic curve (ROC), clinical impact curve, and decision curve analyses were performed to evaluate the robustness and clinical applicability of each model. A total of 30 candidate variables were ultimately included in the rNACT prediction model. The areas under the ROC curve of models constructed using the random forest classifier (RFC), support vector machine, eXtreme gradient boosting, artificial neural network, and decision tree ranged from 0.682 to 0.847. The RFC model had the highest predictive accuracy, which was achieved by incorporating inflammatory factors such as platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, neutrophil-to-albumin ratio, and lymphocyte-to-monocyte ratio. These results demonstrate that the ML-based prediction model developed using the RFC can be used to identify LACC patients who are likely to respond to rNACT, which can guide treatment selection and improve clinical outcomes.
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Affiliation(s)
- Yibao Huang
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Zhu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liru Xue
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoran Zhu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Chen
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingfu Wu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li J, Zhou X, Xiang Y, Zhang S, Feng W, Yuan Y, Liu Y, Yin S. Clinical Significance of Preoperative Fibrinogen to Albumin Ratio in Patients with Glioblastoma: A Singe Center Experience. Cancer Manag Res 2021; 13:3259-3269. [PMID: 33883939 PMCID: PMC8053713 DOI: 10.2147/cmar.s305025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To explore the prognostic value of preoperative fibrinogen to albumin ratio (FAR) in patients with glioblastoma (GBM) and its association with clinical characteristics. Patients and Methods A retrospective analysis was carried out on patients with newly diagnosed GBM who had undergone operation at the Department of Neurosurgery at West China Hospital between June 1st 2015 to June 31st 2018. Receiver operating characteristic (ROC) curves were performed to determine the optimal cut-off values for fibrinogen, albumin, neutrophil to lymphocyte ratio (NLR), and FAR by calculating the maximum Youden index. Kaplan–Meier curves and Cox regression analyses were applied to evaluate the prognostic value of FAR in GBM. Harrell concordance index (C-index) and Akaike information criterion (AIC) were calculated to compare different prognostic models. Results A total of 206 GBM patients were included in this research. The optimal cut-off value for fibrinogen, albumin, NLR, and FAR were 2.57, 42.4, 2.28, and 0.068 respectively. High FAR was significantly related to older age, KPS≤80, IDH-1 wildtype, presence of preoperative seizures, higher NLR, and tumor location. In Cox regression analyses, high FAR was significantly associated with poor prognosis. Prognostic models including FAR had the largest C-index and lowest AIC. Conclusion FAR was determined to be an independent risk factor of prognosis in patients with newly-diagnosed GBM. And the prognostic predictive ability of FAR is stronger than fibrinogen and albumin.
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Affiliation(s)
- Junhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xingwang Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yufan Xiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Shuxin Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Wentao Feng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yunbo Yuan
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Senlin Yin
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
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Li R, Sun Z, Song S, He X, Shi X, Li Z, Song J. NARFIB: A Novel Prognostic Score Based on the Neutrophil-to-Albumin Ratio and Fibrinogen Can Predict the Prognosis of Gastrointestinal Stromal Tumors. Cancer Manag Res 2020; 12:11183-11190. [PMID: 33177869 PMCID: PMC7650032 DOI: 10.2147/cmar.s281375] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
Objective The neutrophil-to-albumin ratio (NAR) and fibrinogen are significantly related to tumor progression. The present study evaluated the prognostic impact of the NAR plus fibrinogen concentration in gastrointestinal stromal tumor (GIST) cases. Methods The baseline characteristics, postoperative NAR, and fibrinogen concentrations were retrospectively analyzed for 229 Chinese patients who underwent radical gastrectomy for GIST. Receiver operating characteristic (ROC) curves were applied to estimate the optimal critical points for NAR and fibrinogen. Cox regression analysis was applied to determine significant prognostic variables. Results Multivariate analyses revealed that poor recurrence-free survival was associated with elevated values for fibrinogen (hazard ratio [HR]: 5.015, 95% confidence interval [CI]: 1.993-12.619, P=0.001) and NAR (HR: 4.669, 95% CI: 1.776-12.273, P = 0.002). Combining fibrinogen and the NAR into the NARFIB score provided an area under the ROC curve of 0.833, which was greater than the areas for NAR (0.708) or fibrinogen (0.778). When the NAR and fibrinogen were replaced by the NARFIB score in the multivariate analysis, the independent prognosticators were tumor site (HR: 2.927, 95% CI: 1.417-6.045, P=0.004), mitotic index (HR: 2.661, 95% CI: 1.110-6.380, P=0.028), and the NARFIB score (HR: 14.116, 95% CI: 3.243-61.443, P<0.001). The NARFIB score retained its prognostic significance in various subgroup analyses and was significantly related to gender, surgical approach, tumor size, mitosis, tumor site, risk classification, and recurrence. Conclusion These results suggest that the NARFIB score may help guide prognostication and risk stratification for GIST, which might benefit from targeted therapy.
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Affiliation(s)
- Rui Li
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Zhen Sun
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Shibo Song
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, People's Republic of China
| | - Xiuwen He
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Xiaolei Shi
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Zhe Li
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, Peking University Fifth School of Clinical Medicine, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
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Lin Y, Wang M, Jia J, Wan W, Wang T, Yang W, Li C, Chen X, Cao H, Zhang P, Tao K. Development and validation of a prognostic nomogram to predict recurrence in high-risk gastrointestinal stromal tumour: A retrospective analysis of two independent cohorts. EBioMedicine 2020; 60:103016. [PMID: 32980695 PMCID: PMC7522759 DOI: 10.1016/j.ebiom.2020.103016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The risk of recurrence in localised, primary gastrointestinal stromal tumour (GIST) classified as high-risk after complete resection varies significantly. Thus, we aimed to develop a nomogram to predict the recurrence of high-risk GIST after surgery to aid patient selection. METHODS We retrospectively evaluated patients (n = 424) with high-risk GIST who underwent curative resection as the initial treatment at two high-volume medical centres, between January 2005 and September 2019. The least absolute shrinkage and selection operator (LASSO) regression model was utilised to select potentially relevant features. Multivariate Cox proportional hazards analysis was used to develop a novel nomogram. FINDINGS The nomogram comprised age, fibrinogen levels, prognostic nutritional index (PNI), platelet-lymphocyte ratio (PLR), mitotic counts and tumour size, which provided favourable calibration and discrimination in the training dataset with an AUC of 0•749 and a C-index of 0•742 (95%CI:0•689-0•804). Further, it showed acceptable discrimination in the validation cohort, with an AUC of 0•778 and C-index of 0•735 (95%CI:0•634-0•846). The time-dependant receiver operating characteristic (ROC) curves performed well throughout the observation period. Additionally, the nomogram could classify high-risk GISTs into 'very high-risk' and 'general high-risk' groups with a hazard ratio (HR) of 5•190 (95%CI: 3•202-8•414) and 5•438 (95%CI: 2•236-13•229) for the training and validation datasets, respectively. INTERPRETATION The nomogram independently predicted post-operative recurrence-free survival (RFS) in high-risk GIST and showed favourable discrimination and calibration values. It may be a useful clinical tool for identifying 'very high-risk' GIST, by allowing treatment strategy optimisation in these patients. FUNDING National Natural Science Foundation of China (No. 81702386 and 81874184).
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Affiliation(s)
- Yao Lin
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Ming Wang
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Jia
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Wenze Wan
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Tao Wang
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Wenchang Yang
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Chengguo Li
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Xin Chen
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China.
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China.
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Guo Y, Liu J, Zhang W, Xiao S, Zheng G, Liu S, Guo M, Zhang H, Feng F. Prognostic Value of Fibrinogen and Lymphocyte Count in Intermediate and High Risk Gastrointestinal Stromal Tumors. Cancer Manag Res 2020; 12:8149-8157. [PMID: 32982412 PMCID: PMC7490054 DOI: 10.2147/cmar.s262570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Data about the prognostic value of fibrinogen concentration and absolute lymphocyte count for the prognosis of gastrointestinal stromal tumors (GISTs) were limited. Thus, the aim of the present study was to investigate the predictive value of preoperative fibrinogen concentration and absolute lymphocyte count in GISTs. Patients and Methods From March 2002 to December 2017, 143 intermediate and high risk GIST patients treated with R0 resection were enrolled in the present study. Clinicopathological characteristics were recorded. The optimal cut-off values of patients were calculated by X-tile software. Categorical variables were analyzed using Chi-square test or Fisher's exact test. Disease-free survival was analyzed by the Kaplan-Meier method and compared by a Log rank test. Results There were 71 males (49.65%) and 72 females. The median age was 56 years (range 19-86). The optimal cut-off value was 4.5 g/L for fibrinogen concentration (P=0.000) and 1.0×109/L for lymphocyte count (P=0.002). No significant association was found between lymphocyte level and clinicopathological features. However, elevated fibrinogen level was correlated with tumor location, tumor size and NIH risk category. Tumor size, fibrinogen concentration and lymphocyte count were independent risk factors for the prognosis of patients according to the multivariate analysis. The prognosis of patients with high fibrinogen concentration or low lymphocyte count was significantly worse than that with low fibrinogen concentration or high lymphocyte count. Further, combination of fibrinogen concentration and lymphocyte count could increase the prognostic value for GIST patients. Conclusion Fibrinogen concentration and absolute lymphocyte count were independent prognostic factors for intermediate and high risk GIST patients. The combination of fibrinogen concentration and absolute lymphocyte count could further increase the predictive value for the prognosis of GIST patients.
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Affiliation(s)
- Yinghao Guo
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China.,Health Company, 92667 Army of PLA, Qingdao 266100, Shandong, People's Republic of China
| | - Jinqiang Liu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China.,Cadre's Sanitarium, 62101 Army of PLA, Xinyang 464000, Henan, People's Republic of China
| | - Wenming Zhang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China.,Department of General Surgery, Linxia People's Hospital, Linxia 731100, Gansu, People's Republic of China
| | - Shuao Xiao
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
| | - Gaozan Zheng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
| | - Shushang Liu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
| | - Man Guo
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
| | - Hongwei Zhang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi, People's Republic of China
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9
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Cao X, Cui J, Yu T, Li Z, Zhao G. Fibrinogen/Albumin Ratio Index Is an Independent Prognosis Predictor of Recurrence-Free Survival in Patients After Surgical Resection of Gastrointestinal Stromal Tumors. Front Oncol 2020; 10:1459. [PMID: 33014783 PMCID: PMC7462001 DOI: 10.3389/fonc.2020.01459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Nutritional status, systemic inflammation, and coagulation mechanism are closely related to tumor progression. Herein, we examined the role of fibrinogen-to-albumin ratio index (FARI) in the prognosis of gastrointestinal stromal tumors (GISTs) and developed a novel nomogram predicting recurrence-free survival (RFS). Methods: We retrospectively analyzed data from 357 GIST patients admitted at the gastrointestinal surgery of the Beijing Hospital from January 2008 to January 2018 and underwent curative resection. FARI was calculated as fibrinogen level (g/L) /albumin level (g/L). The cutoff point of FARI was set using the point with the largest Youden index on the receiver operating characteristic curve with the 5-years recurrence-free survival as an endpoint. We used the Kaplan-Meier approach and multivariable Cox regression model to study the impact of FARI on recurrence-free survival. Finally, we developed a nomogram based on tumor size, location, mitotic index, and FARI to predict RFS. The nomogram was assessed by calculating concordance probabilities and testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with the National Institute of Health (NIH) risk classification system. Results: The ROC curve revealed that the best cutoff point of the FARI was set as 0.08. The patients were classified into the FARI-high (≥0.08) and FARI-low (<0.08) groups. FARI was significantly associated with age, size of the tumor, NIH risk category, and Mitotic Index (all P < 0.05). FARI was weakly associated with NLR and PLR. FARI and PNI had a weak negative association. Multivariate analysis showed that the NIH risk category and FARI were independent prognostic predictors for worse outcomes concerning RFS in GIST patients. In the high-risk subgroup, patients with low FARI also had a more prolonged RFS than patients with high FARI (P < 0.05). The nomogram had a concordance probability of 0.802 (SE 0.025). Nomogram predictions were well-calibrated. Concordance probabilities of the nomogram were better than NIH risk classification system [0.802 [0.025] vs. 0.737 [0.024], p < 0.01]. Conclusion: We established that preoperative FARI is a novel serum biomarker to predict the prognosis after surgical resection of GISTs. The nomogram incorporating FARI could be used to help the decision-making of clinical treatment.
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Affiliation(s)
- Xianglong Cao
- Department of Gastrointestinal Surgery, National Center of Gerontology, Beijing Hospital, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Cui
- Department of Gastrointestinal Surgery, National Center of Gerontology, Beijing Hospital, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Yu
- Department of Gastrointestinal Surgery, National Center of Gerontology, Beijing Hospital, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - ZiJian Li
- Department of Gastrointestinal Surgery, National Center of Gerontology, Beijing Hospital, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, National Center of Gerontology, Beijing Hospital, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Prognostic significance of preoperative plasma fibrinogen levels in primary gastrointestinal stromal tumours: a retrospective cohort study. Int J Clin Oncol 2020; 25:1506-1514. [PMID: 32577952 DOI: 10.1007/s10147-020-01689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improved prediction of prognosis for gastrointestinal stromal tumours (GISTs) has become increasingly important since the introduction of targeted therapy. Here, we aimed to evaluate the prognostic significance of preoperative plasma fibrinogen (Fib) levels in patients with primary GISTs and to analyse their correlations with clinicopathological characteristics. METHODS A total of 201 previously untreated patients with primary GISTs who had undergone radical surgery at our institution between October 2004 and July 2018 were enrolled. The optimal cut-off value for Fib levels was calculated using time-dependent receiver-operating characteristic curve analysis. RFS, the primary endpoint, was calculated by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate Cox regression models were calculated. RESULTS High preoperative plasma Fib levels were detected as an independent adverse prognostic factor (p = 0.008, hazard ratio 3.136, 95% CI 1.356‒7.256). Furthermore, high preoperative plasma Fib levels also indicated a poor prognosis within the modified National Institutes of Health (mNIH) high-risk subgroup (p = 0.041). In addition, preoperative plasma Fib levels showed a positive correlation with several prognostic factors and even a linear relationship with tumour size (Spearman correlation coefficient [r] = 0.411, p < 0.001). CONCLUSIONS Our results suggest that high preoperative plasma Fib levels may indicate a poor prognosis in patients with primary GISTs. As a cost-effective biomarker, preoperative assessment of plasma Fib levels may help to further risk stratify patients with mNIH high-risk GISTs and instruct the application of targeted therapy.
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Cheng M, Liu CH, Horng HC, Chen YJ, Lo PF, Lee WL, Wang PH. Gastrointestinal stromal tumor presenting as a rectovaginal septal mass: A case report and review of literature. Medicine (Baltimore) 2019; 98:e15398. [PMID: 31027138 PMCID: PMC6831160 DOI: 10.1097/md.0000000000015398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) arising from the gynecological tract are extremely rare. A case of GIST with an unusual presentation as a vaginal mass is presented with comprehensive literature review, aiming to gain a better understanding of the diagnostic and treatment strategy of the disease. PATIENT CONCERNS A 78-year-old woman presented with persistent vaginal bleeding and difficulty in micturition. Although the tumor mass was diagnosed, the results of preoperative evaluations are uncertain. DIAGNOSIS Preoperative evaluation included the computed tomography examination (a 6.3×5.3 cm cervical mass lesion with rectal and vaginal invasion), colonoscopy (an external compression with an intact mucosa), tumor markers, and biopsy (spindle cell tumor). Postoperative histopathology confirmed the diagnosis of GIST. INTERVENTIONS Posterior exenteration with complete resection was performed. The patient received postoperative adjuvant imatinib therapy. OUTCOMES The patient has survived without the disease for more than 3 years. CONCLUSION It is still a challenge to diagnose GISTs in women with rectovaginal mass preoperatively. Efforts should be made, including a high suspicion and an assistance of immunohistochemistry. A precise diagnosis may offer a better surgical and treatment plan, especially on the preservation of reproductive organs and accessibility of targeted therapy.
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Affiliation(s)
- Min Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pei-Fen Lo
- Department of Nursing, Taipei Veterans General Hospital
| | - Wen-Ling Lee
- Department of Nursing, Oriental Institute of Technology, New Taipei City
- Department of Medicine, Cheng-Hsin General Hospital
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Cai HX, Li XQ, Wang SF. Prognostic value of fibrinogen and D-dimer-fibrinogen ratio in resectable gastrointestinal stromal tumors. World J Gastroenterol 2018; 24:5046-5056. [PMID: 30510379 PMCID: PMC6262247 DOI: 10.3748/wjg.v24.i44.5046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/27/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prognostic value of preoperative fibrinogen concentration (FIB) and D-dimer-fibrinogen ratio (DFR) in gastrointestinal stromal tumors (GISTs).
METHODS The purpose of this study was to retrospectively analyze 170 patients with GISTs who were admitted to our hospital from January 2010 to December 2015. The optimal cutoff values of related parameters were estimated by receiver operating characteristic (ROC) curve analysis. The recurrence free survival (RFS) rate was evaluated using Kaplan-Meier curves. Univariate analysis and multivariate Cox regression models were used to analyze the prognostic factors of GISTs. The relationship between the FIB, D-dimer, DFR, platelet count (PLT), and the clinicopathological features of GISTs was described by the chi-square test or nonparametric rank sum test (Mann-Whitney test).
RESULTS In ROC analysis, the optimal cutoff values of FIB, D-dimer, DFR, and PLT were 3.24 g/L, 1.24 mg/L, 0.354, and 197.5 (× 109/L), respectively. Univariate analysis and the Kaplan-Meier survival curve showed that FIB, D-dimer, DFR, PLT, National Institutes of Health (NIH) risk category, tumor size, tumor location, and mitotic index were significantly relevant to the 3-year and 5-year survival rate of patients (P < 0.05). Cox multivariate regression analysis illustrated that FIB (RR: 0.108, 95%CI: 0.031-0.373), DFR (RR: 0.319, 95%CI: 0.131-0.777), and NIH risk category (RR: 0.166, 95%CI: 0.047-0.589) were independent prognostic factors of the RFS rate (P < 0. 05). Moreover, FIB, D-dimer, DFR, and PLT were correlated with the clinical features of GISTs.
CONCLUSION FIB, D-dimer, DFR, and PLT are all related to the prognosis of GISTs. Moreover, FIB and DFR may be independent risk factors for predicting the prognosis of resectable GISTs.
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Affiliation(s)
- Hua-Xia Cai
- Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of General Surgery, Xi’an 141 Hospital, Yanliang 710089, Shaanxi Province, China
| | - Xu-Qi Li
- Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shu-Feng Wang
- Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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