title: The elevated pre-operative plasma fibrinogen level is an independent negative prognostic factor for cancer-specific, disease-free and overall survival in soft-tissue sarcoma patients.
abstract: OBJECTIVE
  Accumulating evidence indicates an important pathophysiological role of fibrinogen on tumor cell progression and metastases in different types of cancer. The aim of the present study was to evaluate the prognostic relevance of pre-operative fibrinogen levels on clinical outcome in a large cohort of STS patients.
  
  
  METHODS
  Two hundred ninety-four consecutive STS patients were retrospectively evaluated. Cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS) were assessed using the Kaplan-Meier curves and Cox regression models. Finally, we supplemented the well-established Kattan nomogram by the fibrinogen level and evaluated the gain of predictive accuracy of this novel nomogram by Harrell's concordance index (c-index).
  
  
  RESULTS
  An elevated plasma fibrinogen level was significantly associated with established prognostic factors, including age, tumor grade, size, and depth (P<0.05). Furthermore, in multivariate analysis, increased fibrinogen levels were significantly associated with a poor outcome for CSS (HR=2.48; 95% CI=1.28-4.78; P=0.007), DFS (HR=2.00; 95% CI=1.11-3.60; P=0.021), and OS (HR=2.20; 95% CI=1.39-3.47; P<0.001). The estimated c-index was 0.747 using the original Kattan nomogram and 0.779 when the fibrinogen levels was added.
  
  
  CONCLUSIONS
  The pre-operative plasma fibrinogen level may represent a strong and independent unfavorable prognostic factor for CSS, DFS and OS in STS patients.
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Australia; Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Australia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Szkandera
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.forename: Bernadette
authors.initials: B
authors.lastname: Liegl-Atzwanger
authors.forename: Gudrun
authors.initials: G
authors.lastname: Absenger
authors.forename: Michael
authors.initials: M
authors.lastname: Stotz
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Ploner
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.forename: Hellmut
authors.initials: H
authors.lastname: Samonigg
authors.forename: Katharina
authors.initials: K
authors.lastname: Eberhard
authors.forename: Andreas
authors.initials: A
authors.lastname: Leithner
authors.forename: Armin
authors.initials: A
authors.lastname: Gerger
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D005340:Fibrinogen
keywords: plasma fibrinogen level; prognostic factor; soft-tissue sarcoma