title: Preoperative Plasma Fibrinogen Level as a Significant Prognostic Factor in Patients With Localized Renal Cell Carcinoma After Surgical Treatment.
abstract: We sought to investigate the association of preoperative fibrinogen levels with clinicopathologic outcomes after surgical treatment of nonmetastatic renal cell carcinoma. We reviewed the records of 1511 patients who had their fibrinogen levels measured preceding surgery. The associations between preoperative fibrinogen level and risk of adverse clinicopathologic outcomes were tested using the multivariate logistic regression and multiple Cox-proportional hazards model, respectively. Based on plasma fibrinogen levels, we stratified the patients into 2 groups with a cut-off value of 328  mg/dL. Kaplan-Meier analysis showed significantly inferior survival outcomes in progression-free (P < 0.001), cancer-specific (P < 0.001), and overall survival (P < 0.001). In multivariate analyses, a high fibrinogen level (≥328  mg/dL) was significantly related to a higher Fuhrman grade (hazard ratio [HR] 1.374, P = 0.006) and a larger tumor size (≥7  cm) (HR 2.364, P < 0.001). Multivariate Cox analysis also revealed that a high preoperative fibrinogen level is a significant predictor for poor disease progression (HR 1.857, P < 0.001), cancer-specific survival (HR 3.608, P = 0.003), and overall survival (HR 1.647, P = 0.027). Increased plasma fibrinogen levels were significantly associated with poor pathological features and worse survival outcomes in patients with nonmetastatic renal cell carcinoma after surgical treatment. Further evaluations such as prospective randomized trials are needed to understand the underlying mechanism for these associations.
authors.affiliation: From the Department of Urology, Seoul National University Bundang Hospital, Seongnam (HL, SEL, S-SB, SKH); and Department of Urology, Seoul National University Hospital, Seoul, Korea (HHK, CK).
authors.forename: Hakmin
authors.initials: H
authors.lastname: Lee
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D005340:Fibrinogen
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