title: Plasma fibrinogen and serum C-reactive protein are associated with non-small cell lung cancer.
abstract: OBJECTIVE
  There is an association between coagulation and lung cancer. Therefore, pre-operative plasma fibrinogen and serum C-reactive protein (CRP) concentration were assessed to determine their association with tumour characteristics and to ascertain any role in patient selection for curative resection.
  
  
  METHODS
  These parameters were compared with tumour size, pTNM stage, and possibility of complete resection in 93 patients with non-small cell lung cancer who underwent surgical resection.
  
  
  RESULTS
  Plasma fibrinogen concentration (r(s)=0.34, P=0.001) and serum CRP concentration (r(s)=0.34, P=0.001) were positively correlated with maximum pathological tumour size. A higher plasma fibrinogen concentration was associated with squamous cell carcinoma versus adenocarcinoma (4.5+/-0.13 g/L versus 3.6+/-0.28 g/L; P=0.008), with a trend towards a similar association for CRP (P=0.06). Pathological T stage was also associated with mean plasma fibrinogen and serum CRP concentration (P=0.01 and 0.04, respectively), but pN stage was not associated with either parameter. Incomplete resection occurred in 23% of patients with plasma fibrinogen > 5 g/L or serum CRP > 40 mg/L (versus only 8% when fibrinogen < or = 5 g/L and CRP < or = 40 mg/L; P=0.09).
  
  
  CONCLUSIONS
  Plasma fibrinogen and serum CRP are associated with tumour characteristics. High values were associated with inability to achieve complete resection which may refine patient selection for thoracotomy when used with other staging modalities. Attempted resection may be justified in a patient of borderline fitness who has favourable plasma fibrinogen and serum CRP concentration, where a high resection rate is possible. As the relationship was with T stage rather than N stage it may be complimentary to PET scanning, which has only marginally better accuracy for T stage than CT scanning.
authors.affiliation: Division of Cardiac, Vascular and Thoracic Surgery, Royal Victoria Hospital, Belfast BT12 6BA, UK. mark.jones@royalhospitals.n-i.nhs.uk
authors.forename: J Mark
authors.initials: JM
authors.lastname: Jones
authors.forename: Niall C
authors.initials: NC
authors.lastname: McGonigle
authors.forename: Martin
authors.initials: M
authors.lastname: McAnespie
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Cran
authors.forename: Alastair N
authors.initials: AN
authors.lastname: Graham
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000601:surgery; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000601:surgery; D008297:Male; D011300:Preoperative Care; D011379:Prognosis
chemical_list: D005340:Fibrinogen; D002097:C-Reactive Protein