J Gynecol Oncol.  2017 May;28(3):e36. 10.3802/jgo.2017.28.e36.

Elevated plasma fibrinogen levels and prognosis of epithelial ovarian cancer: a cohort study and meta-analysis

• Luo Y
• Kim HS
• Kim M
• Lee M
• Song YS

• KMID: 2413447
• DOI: http://doi.org/10.3802/jgo.2017.28.e36

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.
CONCLUSION
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.

Keyword

Fibrinogen; Survival; Ovarian Neoplasms, Meta-Analysis

MeSH Terms

Adult
Aged
Aged, 80 and over
Biomarkers, Tumor/*blood
CA-125 Antigen/*blood
Cohort Studies
Disease-Free Survival
Female
Fibrinogen/*analysis
Humans
Lymphocyte Count
Middle Aged
Neoplasms, Glandular and Epithelial/*blood/*mortality/pathology
Neutrophils/cytology
Ovarian Neoplasms/*blood/*mortality/pathology
Predictive Value of Tests
Prognosis
Young Adult
Biomarkers, Tumor
CA-125 Antigen
Fibrinogen

Figure

• 

  Fig. 1. Kaplan-Meier curves for (A) PFS and (B) OS broken down by the mean value (485.2 mg/dL) of plasma fibrinogen levels. OS, overall survival; PFS, progression-free survival.

• 

  Fig. 2. Forest plots for HRs with 95% CIs for the effect of elevated plasma fibrinogen levels on the prognosis of EOC. (A) Effect of plasma fibrinogen levels of >400 mg/dL; (B) increase in plasma fibrinogen levels per 100 units on PFS; (C) effect of plasma fibrinogen levels of >400 mg/dL; and (D) increase in plasma fibrinogen levels per 100 units on OS. CI, confidence interval; EOC, epithelial ovarian cancer; HR, hazard ratio; OS, overall survival; PFS, progression-free survival.

Reference

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