title: Increased preoperative levels of plasma fibrinogen and D dimer in patients with renal cell carcinoma is associated with poor survival and adverse tumor characteristics.
abstract: OBJECTIVE
  The relationship between renal cell carcinoma (RCC) and coagulation/fibrinolysis system has been described in several studies. The aim of this study was to investigate the role of 4 different coagulation/fibrinolysis factors on the prediction of histopathologic and survival prognosis in patients with RCC.
  
  
  METHODS
  Data from 128 patients who underwent surgical intervention between March 2006 and January 2011 for RCC were evaluated in this prospective study. Blood samples were collected from all patients on the morning of the operation to measure the plasma fibrinogen, D-dimer, coagulation factor VII, and antithrombin 3 levels. The relationships of these factors in the demographic, clinical, and histopathologic outcomes were analyzed using the Student t, Mann-Whitney U, Kruskal-Wallis, and one-way analysis of variance tests. Receiver operating curve analyses were performed to determine the optimal cutoff level for fibrinogen and d dimer, both of which had a strong relation with the clinical and histopathologic parameters. Disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed using the Kaplan-Meier method. Multivariate Cox regression analyses (forward stepwise logistic regression) were performed to examine the independent prognostic values on survival outcomes.
  
  
  RESULTS
  Increased plasma fibrinogen and d-dimer levels were associated with tumor size (P = 0.004 and 0.106), nuclear grade (P<0.001 and<0.001), TNM category (P<0.001 and 0.029), and metastasis (P<0.001 and 0.032). Both increased plasma fibrinogen and d-dimer levels predicted decreased DFS (P = 0.027 and 0.04), CSS (P = 0.007 and 0.043), and OS (P = 0.014 and 0.001) rates based on Kaplan-Meier analyses. Furthermore, multivariate analyses demonstrated that fibrinogen independently predicted poor DFS (hazard ratio [HR] = 2.52; 95% CI: 1.04-6.31; P = 0.029) and CSS (HR = 3.89; 95% CI: 1.13-13.40; P = 0.032), whereas d dimer had negative independent prognostic value on OS (HR = 4.01; 95% CI: 1.54-10.50; P = 0.005).
  
  
  CONCLUSIONS
  Increased plasma fibrinogen levels accurately predict poor histopathologic and survival outcomes and may be an effective independent prognostic factor in patients with RCC. Moreover, d dimer may serve as a copredictive factor in conjunction with fibrinogen.
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Erdem
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Akin Soner
authors.initials: AS
authors.lastname: Amasyali
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Aytac
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Onem
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Halim
authors.initials: H
authors.lastname: Issever
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Electronic address: onersanli@hotmail.com.
authors.forename: Oner
authors.initials: O
authors.lastname: Sanli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: Fibrinogen; Renal cell carcinoma; d dimer