title: Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer.
abstract: OBJECTIVE
  To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.
  
  
  METHODS
  This retrospective study analysed 652 patients undergoing surgery for stage I-IV colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related survival.
  
  
  RESULTS
  Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients (53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL (median: 409 mg/dL; range: 143-1045 mg/dL). Preoperative fibrinogen values correlated with age (P= 0.003), completeness of tumour resection, potentially curativevspalliative (P< 0.001), presence of systemic metastasis (P< 0.001), depth of tumour invasion pT (P< 0.001), nodes involvement pN (P= 0.001) and CEA serum level (P< 0.001). The mean fibrinogen value (± SD) was 395.6 ± 120.4 mg/dL in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours (P= 0.045). The overall survival and tumour-related survival were significantly higher in patients with fibrinogen values ≤ 400 mg/dL (P< 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall (P= 0.313) or tumour-related survival (P= 0.355) after controlling for other risk factors in a multivariate analysis.
  
  
  CONCLUSIONS
  Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedrazzani
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Mantovani
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Salvagno
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Baldiotti
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.affiliation: Corrado Pedrazzani, Guido Mantovani, Elisabeth Baldiotti, Andrea Ruzzenente, Calogero Iacono, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002277:Carcinoma / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D009026:Mortality; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D005340:Fibrinogen
keywords: Colorectal cancer; Colorectal surgery; Fibrinogen; Prognosis; Tumour markers