Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 9994-10001
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.9994
Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer
Corrado Pedrazzani, Guido Mantovani, Gian Luca Salvagno, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Giuseppe Lippi, Alfredo Guglielmi
Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
Gian Luca Salvagno, Giuseppe Lippi, Section of Clinical Biochemistry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, 37134 Verona, Italy
Author contributions: Pedrazzani C, Mantovani G and Guglielmi A provided study concept and design; Mantovani G, Salvagno GL and Baldiotti E collected data; Pedrazzani C, Mantovani G and Ruzzenente A performed data analysis and interpretation; Pedrazzani C, Mantovani G drafted the manuscript; Iacono C, Lippi G and Guglielmi A provided critical revision of the paper.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of University of Verona, Verona, Italy, with ID number: 42763 (CRINF-1034 CESC).
Informed consent statement: All study participants, or their legal guardian, provided written consent for data collection and processing, for this study.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: Original data, images, tables are available from the corrisponding author: Dott. Corrado Pedrazzani, Chirurgia Generale e Epatobiliare, Policlinico “G.B. Rossi”, Piazzale Scuro 10, 37134 Verona, Italy. corrado.pedrazzani@univr.it. Partecipants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Corrado Pedrazzani, MD, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy. corrado.pedrazzani@univr.it
Telephone: +39-45-8124464-4655 Fax: +39-45-8027426
Received: July 8, 2016
Peer-review started: July 12, 2016
First decision: July 29, 2016
Revised: October 2, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: December 7, 2016
Processing time: 151 Days and 13.4 Hours
Abstract
AIM

To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.

METHODS

This retrospective study analysed 652 patients undergoing surgery for stage I-IV colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related survival.

RESULTS

Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients (53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL (median: 409 mg/dL; range: 143-1045 mg/dL). Preoperative fibrinogen values correlated with age (P = 0.003), completeness of tumour resection, potentially curative vs palliative (P < 0.001), presence of systemic metastasis (P < 0.001), depth of tumour invasion pT (P < 0.001), nodes involvement pN (P = 0.001) and CEA serum level (P < 0.001). The mean fibrinogen value (± SD) was 395.6 ± 120.4 mg/dL in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours (P = 0.045). The overall survival and tumour-related survival were significantly higher in patients with fibrinogen values ≤ 400 mg/dL (P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall (P = 0.313) or tumour-related survival (P = 0.355) after controlling for other risk factors in a multivariate analysis.

CONCLUSION

Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.

Keywords: Colorectal cancer; Fibrinogen; Tumour markers; Prognosis; Colorectal surgery

Core tip: Fibrinogen is involved in tumourigenesis and in tumour progression in several malignancies. Many studies, particularly from East, have shown a correlation between hyperfibrinogenemia and poor prognosis in patients with colorectal cancer (CRC). This study involves a large cohort of 652 Western patients underwent surgery for CRC. The analysis of our data demonstrates that preoperative fibrinogen plasma levels correlate with leading prognostic factors in patients undergoing surgery for CRC. Although long-term survival and tumour-related survival are worse in patients with hyperfibrinogenemia, these findings are not confirmed in multivariate analysis or after stratification of patients according to completeness of tumour resection and TNM stage.