title: Blood fibrinogen levels discriminate low- and high-risk intraductal papillary mucinous neoplasms (IPMNs).
abstract: BACKGROUND
  The risk assessment of intraductal papillary mucinous neoplasms (IPMN) to either guide patients to surgical resection or watchful waiting is still under debate. Additional markers to better separate low and high-risk lesions would improve patient selection.
  
  
  METHODS
  Patients who underwent pancreatic resections for IPMNs between January 2008 and December 2012 with available blood samples were selected and retrospectively assessed. Data on cyst characteristics such as cyst size, duct relation and main-duct dilatation were collected and plasma fibrinogen levels were measured.
  
  
  RESULTS
  A total of 73 patients fulfilled the inclusion criteria by pancreatic resection for pathologically confirmed IPMN and available blood sample. Histologically, IPMNs were classified as low-grade and borderline in 52 (71.2%, group 1) and as high-grade and invasive in 21 (28.8%, group 2) of all cases. Fibrinogen levels showed significant differences between the two groups (group 1: mean 3.62 g/L (SD ± 1.14); group 2: mean 4.49 g/L (SD ± 1.57); p = 0.027). A ROC-curve analysis calculated cut-off value of 4.71 g/L separated groups 1 and 2 (p = 0.008). Fibrinogen levels remained as the only significant factor in multivariable analysis, cyst size and duct relation were not significant.
  
  
  CONCLUSIONS
  Blood fibrinogen differed between low and high risk IPMNs and therefore, the use of fibrinogen as an additional discriminator in the pre-operative risk assessment of IPMNs should be further evaluated.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: M F
authors.initials: MF
authors.lastname: Nentwich
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Menzel
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reeh
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: F G
authors.initials: FG
authors.lastname: Uzunoglu
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Ghadban
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Bachmann
authors.affiliation: Department of Medicine I, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schrader
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bockhorn
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Germany. Electronic address: d.perez@uke.de.
authors.forename: D
authors.initials: D
authors.lastname: Perez
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000097:blood* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000097:blood* / Q000473:pathology / Q000601:surgery; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D005340:Fibrinogen
keywords: Fibrinogen; IPMN; Risk assessment