Pretreatment elevated fibrinogen level predicts worse oncologic outcomes in upper tract urothelial carcinoma
Pretreatment elevated fibrinogen level predicts worse oncologic outcomes in upper tract urothelial carcinoma
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治疗前纤维蛋白原水平升高预示上尿路尿路上皮癌的肿瘤学结果更差
DOI：
10.4103/aja.aja_38_19
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发表时间：
2019-06
影响因子：
2.9
通讯作者：
Qiang Wei
中科院分区：
文献类型：
--
作者：
Hang Xu;Jian-Zhong Ai;Ping Tan;Tian-Hai Lin;Xi Jin;Li-Na Gong;Hao-Ran Lei;Lu Yang;Qiang Wei
本研究旨在进一步验证纤维蛋白原在中国上尿路上皮癌（UTUC）中的预后作用。共703例接受根治性肾输尿管切除术的患者进行了回顾性分析。纤维蛋白原水平≥4.025 g l−1定义为升高。进行Logistic回归分析，以确定纤维蛋白原和不良病理特征之间的关联。Kaplan-Meier分析和考克斯回归模型用于评估纤维蛋白原与癌症特异性生存期（CSS）、疾病无复发生存期（RFS）和总生存期（OS）的相关性。Harrell c指数和决策曲线分析用于评估多变量模型的临床效用。中位随访时间为42个月（范围：1-168）。Logistic回归分析显示，纤维蛋白原升高与肿瘤的分期、分级、淋巴结转移、淋巴管浸润、无蒂癌、伴发组织学变异、切缘阳性有关（均P < 0.05）。多变量考克斯回归分析表明，纤维蛋白原升高与CSS（风险比[HR]：2.33; P < 0.001）、RFS（HR：2.09; P < 0.001）和OS（HR：2.09; P < 0.001）降低独立相关。当加入纤维蛋白原时，CSS、RFS和OS的多变量模型的预测准确性分别提高了3.2%、2.0%和2.8%。决策曲线分析显示，当纤维蛋白原加入模型时，CSS预测有额外的好处。术前纤维蛋白原可能是UTUC患者肿瘤学结局恶化的一个强有力的独立预测因子;因此，将该标志物应用于UTUC当前的风险分层可能是有价值的。
This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma (UTUC) in a large Chinese cohort. A total of 703 patients who underwent radical nephroureterectomy were retrospectively identified. Fibrinogen levels of ≥4.025 g l−1 were defined as elevated. Logistic regression analysis was performed to determine the association between fibrinogen and adverse pathological features. Kaplan–Meier analysis and Cox regression models were used to assess the associations of fibrinogen with cancer-specific survival (CSS), disease recurrence-free survival (RFS), and overall survival (OS). Harrell c-index and decision curve analysis were used to assess the clinical utility of multivariate models. The median follow-up duration was 42 (range: 1–168) months. Logistic regression analysis revealed that elevated fibrinogen was associated with higher tumor stage and grade, lymph node involvement, lymphovascular invasion, sessile carcinoma, concomitant variant histology, and positive surgical margins (all P < 0.05). Multivariate Cox regression analysis demonstrated that elevated fibrinogen was independently associated with decreased CSS (hazard ratio [HR]: 2.33; P < 0.001), RFS (HR: 2.09; P < 0.001), and OS (HR: 2.09; P < 0.001). The predictive accuracies of the multivariate models were improved by 3.2%, 2.0%, and 2.8% for CSS, RFS, and OS, respectively, when fibrinogen was added. Decision curve analysis showed an added benefit for CSS prediction when fibrinogen was added to the model. Preoperative fibrinogen may be a strong independent predictor of worse oncologic outcomes in UTUC; therefore, it may be valuable to apply this marker to the current risk stratification in UTUC.
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影响因子：
20.3
作者：
J. Palumbo;K. Kombrinck;A. Drew;Timothy S. Grimes;John H. Kiser;J. Degen;T. Bugge
通讯作者：
J. Palumbo;K. Kombrinck;A. Drew;Timothy S. Grimes;John H. Kiser;J. Degen;T. Bugge
影响因子：
11.2
作者：
Steinbrecher KA;Horowitz NA;Blevins EA;Barney KA;Shaw MA;Harmel-Laws E;Finkelman FD;Flick MJ;Pinkerton MD;Talmage KE;Kombrinck KW;Witte DP;Palumbo JS
通讯作者：
Palumbo JS
影响因子：
23.4
作者：
Roupret, Morgan;Babjuk, Marko;Shariat, Shahrokh F.
通讯作者：
Shariat, Shahrokh F.
影响因子：
6.6
作者：
Pichler, Martin;Dalpiaz, Orietta;Hutterer, Georg C.
通讯作者：
Hutterer, Georg C.
影响因子：
5
作者：
Tan, Ping;Xu, Hang;Wei, Qiang
通讯作者：
Wei, Qiang