title: Usefulness of Preoperative Plasma Fibrinogen Versus Other Prognostic Markers for Predicting Gastric Cancer Recurrence.
abstract: Hypercoagulation is associated with tumor progression and metastasis in various types of malignancy. We compared the prognostic value of preoperative plasma fibrinogen level with those of other prognostic markers in patients with gastric cancer and assessed whether fibrinogen level was an independent prognostic indicator.
  
  
  
  We collected preoperative data from 609 consecutive patients with gastric cancer who underwent curative gastrectomy. A receiver operating curve (ROC) was used to compare the sensitivity and specificity of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), C-reactive protein (CRP), platelet count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and fibrinogen level in predicting recurrence. Recurrence-free survival (RFS) and overall survival (OS) were compared between the normal and high fibrinogen groups.
  
  
  
  In the ROC analysis, the area under the curve (AUC) was 0.534 for CEA, 0.552 for CA19-9, 0.587 for CRP, 0.565 for platelet count, 0.567 for PLR, 0.522 for NLR, and 0.692 for fibrinogen. Plasma fibrinogen level increased with tumor stage. The high fibrinogen (≥350 mg/dl) group had significantly worse RFS (p < 0.001) and OS (p < 0.001) than the normal fibrinogen (<350 mg/dl) group. Cox multivariate analysis of RFS revealed that fibrinogen level was an independent prognostic factor (p < 0.001) in addition to sex, pT stage, and pN stage.
  
  
  
  Preoperative plasma fibrinogen level had the highest predictive value for recurrence among seven known prognostic markers. Since fibrinogen level is an independent factor for RFS, it would be useful for predicting prognosis after gastric cancer surgery.
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan. ykurokawa@gesurg.med.osaka-u.ac.jp.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005743:Gastrectomy; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009367:Neoplasm Staging; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012372:ROC Curve; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D005340:Fibrinogen; D002097:C-Reactive Protein