Increased fibrinogen levels at diagnosis are associated with adverse outcome in patients with acute myeloid leukemia
Increased fibrinogen levels at diagnosis are associated with adverse outcome in patients with acute myeloid leukemia
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DOI：
10.1002/hon.2307
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发表时间：
2017-12-01
影响因子：
3.3
通讯作者：
Pabst, Thomas
中科院分区：
文献类型：
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作者：
Berger, Martin D.;Heini, Alexander D.;Pabst, Thomas
在某些实体瘤类型中，血浆纤维蛋白原水平升高与总生存期（OS）缩短相关。相反，急性髓性白血病（AML）诊断时不同纤维蛋白原水平的预后意义尚不清楚。在这项研究中，我们评估了AML患者纤维蛋白原水平的预后意义。在一项全面的回顾性单中心研究中，我们确定了375例连续AML患者的生存率，这些患者至少接受了一个周期的强化化疗诱导治疗。患者在开始治疗前诊断为AML时分为低水平（≥ 4.1 g/L）。随后，应用四分位数范围分析不同纤维蛋白原水平与生存率的相关性。我们观察到低纤维蛋白原组与高纤维蛋白原组的完全缓解率、早期死亡率和入住重症监护室的比率相等。然而，低纤维蛋白原组的OS（27.3 vs 13.5个月; p= 0.0009）以及无进展生存期（12.3 vs 7.8个月; p= 0.0076）明显更好。这种生存差异在多变量分析中仍然显著（p= 0.003）。通过评估纤维蛋白原值的四分位数，我们进一步证实了这一观察结果。我们的数据表明，AML诊断时高纤维蛋白原水平与不良OS和无进展生存期相关，但与诱导治疗期间死亡率增加无关。版权所有（C）2016约翰威利父子有限公司
Increased plasma fibrinogen levels are associated with shortened overall survival (OS) in some solid tumor types. In contrast, the prognostic significance of varying fibrinogen levels in acute myeloid leukemia (AML) at diagnosis is unknown. In this study, we assessed the prognostic significance of fibrinogen levels in AML patients. In a comprehensive retrospective single-center study, we determined the survival rates of 375 consecutive AML patients undergoing at least one cycle of intensive chemotherapy induction treatment. Patients were dichotomized between low (= 4.1 g/L) at diagnosis of AML before initiation of treatment. Subsequently, quartile ranges were applied to analyze the association of varying fibrinogen levels on survival. We observed that the rates of complete remission, early death, and admission to intensive care unit were equal in the low versus high fibrinogen group. Ilowever, OS was significantly better in the low fibrinogen group (27.3 vs 13.5 months; p= 0.0009) as well as progression-free survival (12.3 vs 7.8 months; p= 0.0076). This survival difference remained significant in the multivariate analysis (p= 0.003). Assessing quartiles of fibrinogen values, we further confirmed this observation. Our data suggest that high fibrinogen levels at diagnosis of AML are associated with unfavorable OS and progression-free survival but not with increased mortality during induction treatment. Copyright (C) 2016 John Wiley & Sons, Ltd.