title: Pretransplant Elevated Plasma Fibrinogen Level is a Novel Prognostic Predictor for Hepatocellular Carcinoma Recurrence and Patient Survival Following Liver Transplantation.
abstract: BACKGROUND
  Elevated plasma fibrinogen is associated with tumour progression and poor outcomes in several cancers. The present study investigated the prognostic value of preoperative fibrinogen in hepatocellular carcinoma (HCC) patients after liver transplantation (LT).
  
  
  METHODS
  We analyzed the preoperative plasma fibrinogen levels of 41 patients who underwent LT for HCC. The cut-off value for elevated level of fibrinogen was determined by using a receiver operating characteristic (ROC) curve analysis. Cox regression analysis was performed to analyze the relationship between elevated fibrinogen level and HCC recurrence. The disease-free survival (DFS) and overall survival (OS) rate after transplantation were calculated by Kaplan-Meier method and compared by log-rank test.
  
  
  RESULTS
  The fibrinogen levels were significantly higher in patients with tumor recurrence (3.31±0.98 g/L) compared with those in patients without recurrence (2.39±0.89 g/L) (P<0.01). A cut-off value for elevated fibrinogen level of 2.675 g/L was defined. Cox regression analysis showed that the relative risk for tumor recurrence increased by 6.871 times for patients with elevated fibrinogen. Eleven patients in the elevated fibrinogen group (21 cases) developed recurrence, while only 2 in the normal fibrinogen group (20 cases) developed recurrence. There were significant differences in DFS and OS between the elevated fibrinogen group and normal fibrinogen group (5-year DFS and OS of 44.0% and 42.9% vs. 89.2% and 80.0%, respectively, P<0.05). Vascular invasion and fibrinogen level ≥2.675 g/L were the independent prognostic predictors of tumor recurrence and poor outcome.
  
  
  CONCLUSIONS
  Pretransplant elevated fibrinogen levels are associated with tumor recurrence and poor prognosis in hepatocellular carcinoma patients after liver transplantation.
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Guo-Ying
authors.initials: GY
authors.lastname: Wang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Yi
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Gen-Shu
authors.initials: GS
authors.lastname: Wang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Jian-Wen
authors.initials: JW
authors.lastname: Zhang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Liver Transplant Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
authors.forename: Gui-Hua
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D057234:Preoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D005340:Fibrinogen