title: Preoperative Plasma Fibrinogen Level Represents an Independent Prognostic Factor in a Chinese Cohort of Patients with Upper Tract Urothelial Carcinoma.
abstract: BACKGROUND
  Increased plasma fibrinogen is thought to contribute to tumor progression and metastasis. The association of plasma fibrinogen with clinicopathological characteristics, and the optimal cutoff with an ideal predictive value has not been fully determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the clinical significance of this parameter in a Chinese cohort of patients with UTUC.
  
  
  METHODS
  A retrospective study was conducted to analyze the clinical data of 184 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). An optimal cutoff was set for further analysis according to validated web-based software. The associations of plasma fibrinogen with clinicopathological characteristics and survival were assessed. Multivariate analyses were performed to determine the independent prognostic factors.
  
  
  RESULTS
  Elevated plasma fibrinogen was significantly associated with tumor necrosis, lymph node involvement, and a higher preoperative CKD stage, pathological tumor stage and grade (all P < 0.05). Kaplan-Meier analysis showed that plasma fibrinogen ≥ 3.54 g/L predicted a poorer overall and cancer-specific survival than < 3.54 g/L (P < 0.001 for both). Multivariate analyses revealed that elevated preoperative plasma fibrinogen was an independent negative prognostic factor for overall survival (HR = 2.026; 95% CI: 1.226-3.349; P = 0.006) and cancer-specific survival (HR = 1.886; 95% CI: 1.019-3.490; P = 0.043).
  
  
  CONCLUSIONS
  Increased plasma fibrinogen was an independent prognostic risk factor for poor outcomes in UTUC. This parameter may serve as an effective biomarker with easy accessibility for evaluating prognosis for patients with UTUC.
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Zhou
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Zhi-Song
authors.initials: ZS
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Qun
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Li-Bo
authors.initials: LB
authors.lastname: Liu
authors.affiliation: Peking University Health Science Center, Beijing, People's Republic of China.
authors.forename: Cong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Peking University Health Science Center, Beijing, People's Republic of China.
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Chen
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Wen-Ke
authors.initials: WK
authors.lastname: Han
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000473:pathology / Q000601:surgery; D002681:China; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014571:Urologic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D019459:Urothelium / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D005340:Fibrinogen