title: Validation of the preoperative plasma fibrinogen level as a prognostic factor in a European cohort of patients with localized upper tract urothelial carcinoma.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Martin
authors: M
authors: Pichler
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Orietta
authors: O
authors: Dalpiaz
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Georg C
authors: GC
authors: Ehrlich
authors: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors: Tatjana
authors: T
authors: Stojakovic
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Jessica M
authors: JM
authors: Martín Hernández
authors: Institute of Pathology, Medical University of Graz, Graz, Austria.
authors: Sebastian
authors: S
authors: Mannweiler
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Karl
authors: K
authors: Pummer
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Richard
authors: R
authors: Zigeuner
authors: Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: g.hutterer@gmail.com.
authors: Georg C
authors: GC
authors: Hutterer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000097:blood*; D015331:Cohort Studies; D005060:Europe; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000097:blood*
chemical_list: D005340:Fibrinogen
keywords: carcinoma; fibrinogen; mortality; urinary tract; urothelium