title: Prognostic Impact of Pretreatment Plasma Fibrinogen in Patients with Locally Advanced Oral and Oropharyngeal Cancer.
abstract: BACKGROUND
  We aimed to determine the prognostic significance of pretreatment plasma fibrinigen in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC).
  
  
  METHODS
  A cohort of 183 patients with locally advanced OOSCC receiving preoperative chemoradiotherapy was retrospectively examined. Using ROC curve analysis, a pretreatment plasma fibrinogen cutoff value of 447mg/dL was determined. The primary endpoints were overall survival and recurrence-free survival. A secondary endpoint was to determine whether pretreatment plasma fibrinogen could predict treatment response to neoadjuvant chemoradiotherapy. Cox regression models and Kaplan-Meier curves were used for survival analyses.
  
  
  RESULTS
  Seventy-one patients had an elevated pretreatment plasma fibrinogen (fibrinogen >447mg/dL). Patients with high fibrinogen showed significantly higher pathologic stages after neoadjuvant treatment than those with low fibrinogen (p = 0.037). In univariate analysis, elevated fibrinogen was associated with poor overall survival (p = 0.005) and recurrence-free survival (p = 0.008) Multivariate analysis revealed that elevated fibrinogen remained an independent risk factor for death (hazard ratio 1.78, 95% CI 1.09-2.90, p = 0.021) and relapse (hazard ratio 1.78, 95% CI 1.11-2.86, p = 0.016).
  
  
  CONCLUSIONS
  Elevated pretreatment plasma fibrinogen is associated with lack of response to neoadjuvant chemoradiotherapy and reduced OS and RFS in patients with OOSCC. Thus, plasma fibrinogen may emerge as a novel prognostic indicator and a potential therapeutic target in OOSCC.
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Holzinger
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Ivan
authors.initials: I
authors.lastname: Danilovic
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.affiliation: Department of Medicine I, Medical University of Vienna, Austria.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Kornek
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Engelmann
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Pillerstorff
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Simone
authors.initials: S
authors.lastname: Holawe
authors.affiliation: Division of Oncology, Second Department of Internal Medicine, Attikon University Hospital, Athens, Greece.
authors.forename: Amanda
authors.initials: A
authors.lastname: Psyrri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of Vienna, Austria.
authors.forename: Boban M
authors.initials: BM
authors.lastname: Erovic
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, United States of America.
authors.forename: Gregory
authors.initials: G
authors.lastname: Farwell
authors.affiliation: Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
authors.forename: Christos
authors.initials: C
authors.lastname: Perisanidis
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D009959:Oropharyngeal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D005340:Fibrinogen