title: The association of an elevated plasma fibrinogen level with cancer-specific and overall survival in prostate cancer patients.
abstract: OBJECTIVE
  Fibrinogen plays an important role in the pathophysiology of tumour cell invasion and metastases. In recent studies, an elevated plasma fibrinogen level has been associated with poor prognosis in different types of cancer. The present study was performed to analyse the prognostic impact of an elevated fibrinogen level in prostate cancer patients.
  
  
  METHODS
  We evaluated data from 268 prostate cancer patients who underwent 3D conformal radiotherapy between 1999 and 2006 at a single tertiary academic center. Cancer-specific survival (CSS), overall survival (OS), and clinical disease-free survival (DFS) were assessed using the Kaplan-Meier method. Univariable and multivariable Cox regression models were performed for each endpoint.
  
  
  RESULTS
  Applying receiver operating characteristics (ROC) curve analysis, the optimal cut-off level for the plasma fibrinogen level was 530 mg dl(-1), respectively. Univariable (HR 3.638, 95 % CI 1.15-11.47, p = 0.027) and multivariable analyses (HR 3.964, 95 % CI 1.06-14.87, p = 0.041) revealed a significant correlation between increased plasma fibrinogen and CSS. Univariable analysis also showed a significant association between the elevated plasma fibrinogen level and decreased OS (HR 3.242, 95 % CI 1.53-6.89, p = 0.002), that remained significant in multivariable analysis (HR 3.215, 95 % CI 1.44-7.19, p = 0.004). No significant associations were found for clinical DFS.
  
  
  CONCLUSIONS
  Although our data show a significant association between an elevated plasma fibrinogen level and poor prostate cancer prognosis, they have to be interpreted cautiously. Limitations of the present study are caused by its retrospective design, the limited accuracy obtained using ROC curve analysis, and potential confounding factors like cardiovascular disease and inflammatory diseases that have not been accounted for.
authors.affiliation: Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Thurner
authors.affiliation: Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Krenn-Pilko
authors.affiliation: Division of Internal Medicine, Outpatient Department Graz, Graz, Austria.
authors.forename: Uwe
authors.initials: U
authors.lastname: Langsenlehner
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Armin
authors.initials: A
authors.lastname: Gerger
authors.affiliation: Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
authors.forename: Karin S
authors.initials: KS
authors.lastname: Kapp
authors.affiliation: Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria. tanja.langsenlehner@medunigraz.at.
authors.forename: Tanja
authors.initials: T
authors.lastname: Langsenlehner
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood*; D018450:Disease Progression; D018572:Disease-Free Survival; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000532:radiotherapy; D012372:ROC Curve; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D014408:Biomarkers, Tumor; D005340:Fibrinogen
keywords: Coagulation; Fibrinogen; Prognosis; Prostate cancer; Radiotherapy