title: Elevated plasma fibrinogen levels and prognosis of epithelial ovarian cancer: a cohort study and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect of elevated plasma fibrinogen levels on the prognosis of epithelial ovarian cancer (EOC).
  
  
  METHODS
  We reviewed the data of 217 patients with advanced-stage EOC between 2000 and 2012, and investigated the prognostic role of elevated plasma fibrinogen levels compared with serum CA-125 levels, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). For further evaluation, we performed a meta-analysis using 5 cohort studies published to July 2015, including our cohort study after a literature review.
  
  
  RESULTS
  Among the four biomarkers, only plasma fibrinogen levels >485.2 mg/dL were correlated with impaired progression-free survival (PFS) and overall survival (OS) (median, 13.9 vs. 20.3 months and 42.2 vs. 55.4 months; p<0.010). Elevated plasma fibrinogen levels were an independent factor for poor PFS with marginal significance and OS (adjusted hazard ratios [HRs]=1.389 and 1.581; 95% confidence intervals [CIs]=0.979-1.972 and 1.032-2.423, respectively). Furthermore, crude and subgroup meta-analyses demonstrated that elevated plasma fibrinogen levels were associated with impaired PFS and OS in patients with all stage EOC.
  
  
  CONCLUSIONS
  Elevated plasma fibrinogen levels be more important for predicting survival than serum CA-125 levels, NLR and PLR in patients with EOC, in particular, advanced-stage disease. Moreover, it may be related to poor prognosis of EOC.
authors.affiliation: Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China.
authors.forename: Yanlin
authors.identifier: http://orcid.org/0000-0001-7855-3121
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Seung
authors.identifier: http://orcid.org/0000-0001-6876-8671
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoungnam, Korea.
authors.forename: Miseon
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-8017-3176
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. yssong@snu.ac.kr.
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D018655:Lymphocyte Count; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D009504:Neutrophils / Q000166:cytology; D010051:Ovarian Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D005340:Fibrinogen
keywords: Fibrinogen; Ovarian Neoplasms, Meta-Analysis; Survival