Validation of the Preoperative Plasma Fibrinogen Level as a Prognostic Factor in a European Cohort of Patients with Localized Upper Tract Urothelial Carcinoma
Validation of the Preoperative Plasma Fibrinogen Level as a Prognostic Factor in a European Cohort of Patients with Localized Upper Tract Urothelial Carcinoma
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DOI：
10.1016/j.juro.2013.10.073
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发表时间：
2014-04-01
影响因子：
6.6
通讯作者：
Hutterer, Georg C.
中科院分区：
文献类型：
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作者：
Pichler, Martin;Dalpiaz, Orietta;Hutterer, Georg C.
目的：纤维蛋白原被认为在不同人类癌症的进展和转移扩散中具有潜在的重要作用。最近一项来自亚洲的研究表明，术前血浆纤维蛋白原升高可能与手术治疗的局限性上尿路上皮癌患者的预后不良相关。我们验证了这种潜在的生物标志物的预后影响，在欧洲队列的患者局部上尿路尿路上皮carcinoma.Materials和方法：我们评估了167例非转移性上尿路上皮癌患者的数据，他们在1990年和2012年之间接受手术，在一个单一的三级学术中心。使用术前血浆纤维蛋白原的最佳临界值对患者进行分类。使用Kaplan-Meier方法评估患者癌症特异性和总生存期。对每个终点进行单变量和多变量考克斯回归模型分析。通过Harrell c指数进一步确定纤维蛋白原对多变量模型预测准确性的影响。多变量分析确定术前血浆纤维蛋白原增加是癌症特异性生存的独立预后因素（HR 3.00，95% CI 1.32-6.80，p = 0.008）和总生存期（HR 2.48，95% CI 1.31-4.68，p = 0.005）。在无纤维蛋白原的情况下，癌症特异性生存的多变量模型的估计c指数为0.72，在加入纤维蛋白原的情况下为0.74。我们建立的风险模型显著区分了低、中、高风险组的癌症相关死亡（p < 0.001）。结论：纤维蛋白原升高似乎是上尿路上皮癌患者癌症特异性和总生存率的一个负面预后因素。此参数应被认为是一个额外的预后因素上尿路上皮癌在未来。
Purpose: Fibrinogen is thought to have a potentially significant role in the progression and metastatic spread of different human cancers. A recent study from Asia indicated that elevated preoperative plasma fibrinogen might be associated with a worse outcome in patients with surgically treated localized upper tract urothelial carcinoma. We validated the prognostic impact of this potential biomarker in a European cohort of patients with localized upper tract urothelial carcinoma.Materials and Methods: We evaluated data on 167 patients with nonmetastatic upper tract urothelial carcinoma who underwent surgery between 1990 and 2012 at a single tertiary academic center. Patients were categorized using an optimal cutoff value of preoperative plasma fibrinogen. Patient cancer specific and overall survival was assessed using the Kaplan-Meier method. Univariate and multivariate Cox regression models were performed for each end point. The influence of fibrinogen on the predictive accuracy of the multivariate model was further determined by the Harrell c-index.Results: Multivariate analysis identified increased preoperative plasma fibrinogen as an independent prognostic factor for cancer specific survival (HR 3.00, 95% CI 1.32-6.80, p = 0.008) and overall survival (HR 2.48, 95% CI 1.31-4.68, p = 0.005). The estimated c-index of the multivariate model for cancer specific survival was 0.72 without fibrinogen and 0.74 when fibrinogen was added. The risk model that we developed significantly differentiated between low, intermediate and high risk groups for cancer related death (p < 0.001).Conclusions: Elevated fibrinogen seems to represent a negative prognostic factor for cancer specific and overall survival in patients with upper tract urothelial carcinoma. This parameter should be considered an additional prognostic factor for upper tract urothelial carcinoma in the future.