Prognostic significance of preoperative plasma fibrinogen in endometrial cancer
Prognostic significance of preoperative plasma fibrinogen in endometrial cancer
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DOI：
10.1016/j.ygyno.2010.07.014
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发表时间：
2010-11-01
影响因子：
4.7
通讯作者：
Franchi, Massimo
中科院分区：
文献类型：
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作者：
Ghezzi, Fabio;Cromi, Antonella;Franchi, Massimo
Objective.在大量子宫内膜癌患者队列中，研究术前血浆纤维蛋白原浓度对预后的意义，特别关注肿瘤扩散和淋巴结受累。研究人群包括2000年至2009年在两个三级机构接受手术分期的336名子宫内膜癌妇女。通过Clauss测定法测定来自研究队列的治疗前血浆样本的纤维蛋白原。从前瞻性收集数据的数据库中收集人口统计学、实验室检查、组织病理学和随访信息。在考克斯比例风险模型中确定与生存相关的因素。单因素和多因素分析用于评估宫外病变和淋巴结转移的预测因素。137例（40.8%）患者表现出术前高纤维蛋白原血症。单因素分析显示，组织学类型、肿瘤分级、肌层浸润深度、手术分期、患者年龄和高纤维蛋白原血症显著影响无病生存率和总生存率。当这些变量同时进入考克斯回归模型时，术前血浆纤维蛋白原水平升高仍是DFS（HR 2.0，95%CI 1.1-3.6）和总生存率（HR 2.7，95%CI 1.3-5.5）的不良指标。术前高纤维蛋白原血症是子宫外疾病的独立决定因素（OR 2.7，95%CI 1.3-5.6）。在类纤维蛋白原组中，纤维蛋白原浓度升高是盆腔淋巴结受累的预测因子（OR 3.6，95%CI 1.1-11.7）。血浆纤维蛋白原水平可能在预测结果中具有价值，在诊断时根据复发风险改善子宫内膜癌患者的分层，并可能相应地改变其治疗。(C)2010年爱思唯尔公司All rights reserved.
Objective. To investigate the prognostic significance of preoperative plasma fibrinogen concentration, with particular focus on tumor dissemination and nodal involvement, in a substantial cohort of patients with endometrial cancer.Methods. The study population comprised 336 women with endometrial cancer who underwent surgical staging at two tertiary institutions, from 2000 to 2009. Pretreatment plasma samples from the study cohort were assayed for fibrinogen by the Clauss assay. Information on demographics, laboratory testing, histopathology and follow-up was gathered from databases of prospectively collected data. Factors associated with survival were identified in a Cox proportional hazards model. Univariate and multivariate analyses were used to evaluate predictors of extrauterine disease and nodal metastasis.Results. One-hundred-thirty-seven (40.8%) patients exhibited preoperative hyperfibrinogenemia. Univariate analysis demonstrated that histological type, tumor grade, depth of myometrial invasion, surgical stage, patient age, and hyperfibrinogenemia affect disease-free (DFS) and overall survival rates significantly. When these variables were entered simultaneously into a Cox regression model, raised preoperative levels of plasma fibrinogen retained significance as poor prognosticator of DFS (HR 2.0, 95%CI 1.1-3.6) and overall survival (HR 2.7, 95%CI 1.3-5.5). Preoperative hyperfibrinogenemia was an independent determinant of extrauterine disease (OR 2.7, 95%CI 1.3-5.6). In the subcohort of women with endometrioid histology, increased fibrinogen concentration at presentation was predictive of pelvic nodal involvement (OR 3.6, 95%CI 1.1-11.7).Conclusion. Plasma fibrinogen level may be of value in the prediction of outcome, improve the stratification of endometrial cancer patient, at diagnosis, based on their risk of recurrence, and possibly alter their treatment accordingly. (C) 2010 Elsevier Inc. All rights reserved.