Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2018; 24(13): 1451-1463
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1451
Prognostic significance of combined preoperative fibrinogen and CA199 in gallbladder cancer patients
Wei-Yu Xu, Hao-Hai Zhang, Xiao-Bo Yang, Yi Bai, Jian-Zhen Lin, Jun-Yu Long, Jian-Ping Xiong, Jun-Wei Zhang, Xin-Ting Sang, Hai-Tao Zhao
Wei-Yu Xu, Hao-Hai Zhang, Xiao-Bo Yang, Yi Bai, Jian-Zhen Lin, Jun-Yu Long, Jian-Ping Xiong, Jun-Wei Zhang, Xin-Ting Sang, Hai-Tao Zhao, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Xu WY, Zhang HH and Yang XB contributed equally to this work. Xu WY conceived, designed and wrote the manuscript that led to the submission; Xu WY, Yang XB, Bai Y and Zhang JW collected the clinical data and followed up the patients; Lin JZ, Long JY and Xiong JP helped to analyze the data, Bai Y revised the manuscript, Sang XT and Zhao HT provided financial support for this work; Sang XT and Zhao HT are co-corresponding authors, and contributed equally to this work; all authors read and approved the final manuscript.
Supported by National Key Project Research and Development Projects, No. S2016G9012; International Science and Technology Cooperation Projects, No. 2015DFA30650; and The Capital Special Research Project for Clinical Application, No. Z151100004015170.
Institutional review board statement: The publication of this manuscript has been reviewed and approved by the PUMCH institutional review board.
Informed consent statement: All patients and their families signed informed consent statements before surgery, and the type of surgical procedure was performed according to the approved guidelines.
Conflict-of-interest statement: We declare that the authors have no conflict of interest.
Data sharing statement: No additional data are available.
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: Hai-Tao Zhao, MD, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. zhaoht@pumch.cn
Telephone: +86-10-69156042 Fax: +86-10-69156042
Received: January 26, 2018
Peer-review started: January 26, 2018
First decision: February 10, 2018
Revised: March 7, 2018
Accepted: March 10, 2018
Article in press: March 10, 2018
Published online: April 7, 2018
Processing time: 68 Days and 4.9 Hours
Abstract
AIM

To investigate the prognostic value of the combination of preoperative plasma fibrinogen and CA199 in patients with gallbladder carcinoma (GBC).

METHODS

The clinicopathological data of 154 GBC patients were retrospectively reviewed after surgery. A receiver operating characteristic (ROC) curve was plotted to verify the optimum cut-off values for plasma fibrinogen and CA199. Univariate and multivariate survival analyses were performed to identify the factors associated with GBC prognosis. Based on the HRs calculated via multivariate survival analyses, patients with elevated plasma fibrinogen and CA199 levels were allocated a score of 2.1; those with an elevated plasma fibrinogen level only were allocated a score of 1, those with an elevated CA199 level only were allocated a score of 1.1, and those with neither of these abnormalities were allocated a score of 0.

RESULTS

ROC curve analysis showed that the optimum cut-off values for preoperative plasma fibrinogen and CA199 were 3.47 g/L and 25.45 U/mL, respectively. Multivariate analysis indicated that elevated preoperative plasma fibrinogen and CA199 levels were significantly correlated with worse overall survival (OS) (HR = 1.711, 95%CI: 1.114-2.627, P = 0.014, and HR = 1.842, 95%CI: 1.111-3.056, P = 0.018). When we combined these two parameters, the area under the ROC curve increased from 0.735 (for preoperative plasma fibrinogen only) and 0.729 (for preoperative CA199 only) to 0.765. When this combined variable was added to the multivariate analysis, the combination of plasma fibrinogen and CA199 (P < 0.001), resection margin (P < 0.001) and TNM stage (P = 0.010) were independent prognostic factors for GBC.

CONCLUSION

The combination of plasma fibrinogen and CA199 may serve as a more efficient independent prognostic biomarker for postoperative GBC patients than either parameter alone.

Keywords: Prognostic factor; Plasma fibrinogen; CA199; Survival; Gallbladder cancer

Core tip: Elevated plasma fibrinogen and CA199 levels are associated with poor prognosis in patients with gallbladder carcinoma (GBC). The prognostic value of the combination of plasma fibrinogen and CA199 for GBC has not been reported. The most important finding in this study was that the combination of preoperative plasma fibrinogen and CA199 levels was a better independent prognostic indicator for GBC than either parameter alone.