title: Prognostic significance of hyperfibrinogenemia in patients with esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Preoperative hyperfibrinogenemia is associated with inflammatory mediators and a poor prognosis in several types of cancer. However, there is no published information on the monitoring of patients with preoperative hyperfibrinogenemia after surgery. The aim of the study reported here was to assess the clinicopathological and prognostic significance of plasma fibrinogen levels in patients with esophageal squamous cell carcinoma before and after surgical treatment.
  
  
  METHODS
  Plasma fibrinogen levels were analyzed before surgical treatment (endoscopic submucosal dissection and surgery) in 82 patients with esophageal squamous cell carcinoma. The clinicopathological significance of plasma fibrinogen levels and the relationship of plasma fibrinogen levels with several biomarkers were evaluated. The cutoff value for hyperfibrinogenemia was 321 mg/dl. Univariate and multivariate analysis using the Cox proportional hazards model were performed to evaluate the prognostic significance of plasma fibrinogen levels. The changing patterns of plasma fibrinogen were monitored after surgical treatment to evaluate prognostic impact.
  
  
  RESULTS
  Hyperfibrinogenemia was significantly associated with advanced pathological stage of cancer and high C-reactive protein levels. Plasma fibrinogen levels significantly decreased after surgical treatment in recurrence-free patients but did not decrease in patients with recurrence. The multivariate analysis indicated that preoperative hyperfibrinogenemia was an independent prognostic factor for poor survival (hazard ratio 1.005, 95% confidence interval 1.000-1.010; P = 0.039).
  
  
  CONCLUSIONS
  Preoperative hyperfibrinogenemia was associated with inflammatory mediators, tumor progression, and poor survival in patients with esophageal squamous cell carcinoma. The absence of a decrease in plasma fibrinogen levels after surgical treatment may indicate the possibility of tumor recurrence.
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan. hideaki.shimada@med.toho-u.ac.jp.
authors.forename: Hideaki
authors.identifier: http://orcid.org/0000-0002-1990-8217
authors.initials: H
authors.lastname: Shimada
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Nanami
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yajima
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Washizawa
authors.affiliation: Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D011517:Prothrombin Time; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: Esophageal squamous cell carcinoma; Fibrinogen; Hyperfibrinogenemia; Prognosis