Usefulness of Preoperative Plasma Fibrinogen Versus Other Prognostic Markers for Predicting Gastric Cancer Recurrence

Construction and validation of a novel prognostic nomogram for patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND

The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms (PDGNENs) is dismal and related research is limited.

AIM

To investigate the prognostic factors, and validate a novel prognostic nomogram for PDGNEN patients.

METHODS

We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023. Overall survival (OS) differences were assessed with the Log-rank test and Kaplan-Meier survival curves. Cox regression analysis identified independent risk factors for prognosis. Model performance was evaluated using Harrell's concordance index, receiver operating characteristic analysis, area under the curve, calibration curves, and decision curve analysis (UDC), including the area under the UDC.

RESULTS

The study included 336 patients (227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma). The average age was 62.7 years. The cohort comprised 80 (24.7%) patients in stage I, 146 (42.9%) in stage II, 62 (18.1%) in stage III, and 48 (14.3%) in stage IV. Significant differences in OS were observed across tumor-node-metastasis stages (P < 0.001). Multivariate analysis showed age, Ki-67 index, invasion depth, lymph node metastasis, distant metastasis, and platelet-to-lymphocyte ratio as independent risk factors. We developed a nomogram with a concordance index of 0.779 (95% confidence interval: 0.743-0.858). Receiver operating characteristic analysis showed area under the curves for 1-year, 3-year, and 5-year OS predictions of 0.865, 0.850, and 0.890, respectively. The calibration curve demonstrated good agreement with actual outcomes. The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027, 0.291 vs 0.179, and 0.376 vs 0.216 for 1-year, 3-year, and 5-year OS, respectively.

CONCLUSION

PDGNENs are predominantly found in older men, often in advanced stages at diagnosis, resulting in poor prognosis. The established nomogram demonstrates strong predictive capability and clinical utility.

Development of a prognostic oxidative stress-immune-inflammation score and online calculators for predicting survival and recurrence in gastric cancer: a multicenter study

BACKGROUND

Oxidative stress, immune response, and inflammation play an important role in the occurrence and progression of gastric cancer (GC). This study is to develop a novel prognostic oxidative stress-immune-inflammation score (POSII score) and to explore the clinical value of the novel nomograms incorporating this factor in survival and recurrence risk.

METHODS

This study included 3612 GC patients who underwent radical gastrectomy at three tertiary hospitals from 2009 to 2020. One hospital formed the training and internal validation cohorts, while the other two constituted the external validation cohort. Twelve hematological markers were collected and analyzed to develop the POSII score via LASSO regression. Two online calculators were developed and validated.

RESULTS

The POSII score categorized patients into low and high POSII groups, with the low POSII group showing significantly improved 5-year overall survival (OS) and disease-free survival (DFS) rates, as well as a markedly reduced risk of recurrence (all P < 0.05). Multivariate COX regression showed that the POSII score was an independent prognostic factor. Based on the POSII score, two nomograms (OS: AUC = 0.837; DFS: AUC = 0.834, respectively) for individualized prognostic prediction were constructed. To enhance clinical usability, we further developed two user-friendly online calculators. The high-risk group had an earlier, more persistent peak of recurrence and a high incidence of multiple recurrence patterns.

CONCLUSION

Two novel online calculators based on the POSII score can be used as reliable tools for predicting survival and recurrence after radical gastrectomy. Our findings provide new insights into the role of cancer-related immune dysregulation, inflammation, and oxidative stress imbalances.

Diagnostic and Predictive Recurrence Value of Plasma Fibrinogen in Patients With Adrenocortical Carcinoma

Background

The correlation between fibrinogen levels and adrenocortical carcinoma (ACC) remains unclear. This study aimed to explore the value of preoperative plasma fibrinogen as a biomarker for ACC.

Methods

We identified 40 patients with ACC and 170 patients with adrenal adenoma (AA) who underwent surgery at our institution between 2015 and 2022. Plasma fibrinogen levels and postoperative tumor recurrence information of the patients were also recorded. For intergroup comparisons, data obtained from the AA and ACC groups were evaluated using a t-test. The cutoff value of fibrinogen level was determined using a receiver operating characteristic (ROC) curve.

Results

Mean fibrinogen levels in the AA and ACC groups were 2.81 ± 0.59 g/L and 3.88 ± 1.75 g/L, respectively (P < .001). Fibrinogen level, which can help distinguish between AA and ACC, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.87 g/L according to the Youden index. With this value, the sensitivity was 62.5%, specificity was 95.7%, and the area under the ROC curve (AUC) was 0.74 (P < .001). Fibrinogen level, which can help distinguish between recurrence and non-recurrence, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.96 g/L according to the Youden index. The sensitivity, specificity, and AUC were 90%, 71.4%, and 0.85, respectively (P < .001).

Conclusion

According to the data in this study, plasma fibrinogen could be used to distinguish ACC from AA. Most importantly, plasma fibrinogen may be used to identify recurrence of postoperative ACC.

Prognostic value of fibrinogen change value in adrenocortical carcinoma patients

PURPOSE

The aim was to explore the preoperative and postoperative fibrinogen changes value (FCV) as a prognosis biomarker for in patients with adrenocortical carcinoma (ACC).

METHODS

We identified 42 patients with ACC and 190 patients with adrenal adenoma (AA) who underwent surgery at our institution between 2015 and 2023. Preoperative fibrinogen, postoperative fibrinogen and follow-up information of the patients were recorded and analysed. The relationship between FCV and overall survival (OS)/ relapse-free survival (RFS) was evaluated.

RESULTS

The mean level of preoperative and postoperative fibrinogen for ACC were 4.00 ± 1.64 g/L and 2.75 ± 0.59 g/L, respectively (p < 0.001). The mean level of preoperative and postoperative fibrinogen for AA were 2.79 ± 0.59 g/L and 2.71 ± 0.58 g/L, respectively (p = 0.144). In ACC, the lower FCV (≤ 1.25 g/L) showed a significantly poorer RFS than the higher (> 1.25 g/L) (p = 0.007); however, the lower FCV (≤ 1.25 g/L) showed no poorer OS than the higher (> 1.25 g/L) (p = 0.243). On multivariate survival analyses, FCV remained a predictor of RFS (HR 3.138).

CONCLUSION

According to the data in this study, it can be said that FCV is correlated with prognosis of ACC. The FCV might be a new biomarker for predicting the RFS of ACC.

Prognostic Value of a Novel Index Combining the Prognostic Nutritional Index and D-Dimer Levels for Gastric Cancer after Gastrectomy

INTRODUCTION

The prognostic nutritional index (PNI) and D-dimer level are two useful measures for gastric cancer prognosis. As they each comprise different factors, it is possible to employ a more useful combined indicator. This study therefore aimed to establish a PNI-D score - which combines the PNI and D-dimer level - and validate its usefulness as a prognostic marker.

METHODS

We collected data from 1,218 patients with gastric cancer who had undergone radical gastrectomy (R0) between January 2004 and December 2015. Patients were divided into three PNI-D score groups based on the following criteria: score 2, low-PNI (≤46) and high D-dimer levels (>1.0 µg/mL); score 1, either low-PNI or high D-dimer levels; and score 0, no abnormality. We defined the PNI-D score as low (score 0 or 1) and high (score 2), respectively.

RESULTS

The PNI-D score was significantly associated with overall, recurrence-free, and disease-specific survival (all log-rank p < 0.0001). The 5-year overall survival rates of patients with PNI-D scores of low and high were 88.1% and 64.7%, respectively; their 5-year recurrence-free survival rates were 86.7% and 61.3%, respectively; and their 5-year disease-specific survival rates were 99.3% and 76.5%, respectively. Cox multivariate analysis revealed that a high-PNI-D score was an independent, statistically significant prognostic factor for poor overall (p = 0.01) survival in patients with gastric cancer.

CONCLUSIONS

The PNI-D is an independent prognostic factor for patients with gastric cancer.

Nomogram Based on Preoperative Fibrinogen and Systemic Immune-Inflammation Index Predicting Recurrence and Prognosis of Patients with Borrmann Type III Advanced Gastric Cancer

Background and Objectives

The prognosis is known to differ significantly among advanced gastric cancer (AGC) with Borrmann type III. This study aimed to evaluate the prognosis of these patients more individually.

Methods

We selected 542 AGC patients with Borrmann type III. We used the receiver operating characteristic curve to analyze the cutoff values of inflammation indexes, and used Kaplan-Meier and Log rank tests to analyze recurrence-free survival (RFS) and overall survival (OS). The independent risk factors for recurrence and prognosis were analyzed by Cox proportional hazards regression model. The nomogram models were constructed by R studio.

Results

Patients with high preoperative fibrinogen (F) and systemic immune-inflammation index (SII) levels had worse RFS and OS and higher risk of postoperative locoregional recurrence, hematogenous metastasis and lymph node metastasis. F and SII can combine with different clinicopathological features (all P<0.05) to construct nomograms to predict 5-year recurrence and prognosis, which both were superior to pTNM stage alone.

Conclusion

The nomogram models based on F and SII can evaluate AGC with Borrmann type III postoperative recurrence and prognosis.

Prognostic Impact of Using Combined Plasma Fibrinogen Level and Neutrophil-to-Lymphocyte Ratio in Resectable Non-small Cell Lung Cancer

BACKGROUND

Both plasma fibrinogen level and neutrophil-to-lymphocyte ratio (NLR) are associated with malignant potential in different cancer types. The current study evaluated the use of combined plasma fibrinogen level and NLR (F-NLR) as a prognostic predictor in patients with non-small cell lung cancer (NSCLC).

METHODS

Data collected from 279 patients with resectable NSCLC were retrospectively reviewed. Patients were divided into three groups based on the F-NLR score: score 2, high fibrinogen level (≥350 mg/dL) and high NLR (≥2.5); score 1, either high fibrinogen level or high NLR; and score 0, neither abnormal. Overall survival (OS) and relapse-free survival (RFS) were evaluated using the Kaplan-Meier method and log-rank test. Cox proportional hazard model was used to assess prognostic factors.

RESULTS

Numbers of patients with F-NLR score of 0, 1, and 2 were 122 (43.7%), 105 (37.6%), and 52 (18.6%), respectively. The F-NLR was found to be significantly associated with age, male sex, heavy smoking history, high pT status and pathological stage, and nonadenocarcinoma. Moreover, the OS and RFS significantly differed according to the F-NLR score (P < 0.001, P = 0.003). A multivariate analysis revealed that a high F-NLR score (≥1) was an independent poor prognostic factor for OS (P = 0.027). In subgroup analyses, an adverse prognostic impact of the F-NLR score on OS was identified regardless of nodal involvement or pathological stage.

CONCLUSIONS

The F-NLR score, which is based on histological inflammation and coagulability, could be a potential prognostic indicator in patients with resectable NSCLC.

The Significance of Fibrinogen in Combination with the Neutrophil to Lymphocyte Ratio in Predicting the Prognosis of Patients with Gastric Cancer

Objective

To investigate the significance of fibrinogen (Fib) in combination with the neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients with gastric cancer.

Methods

The preoperative peripheral blood-related indicators of 281 gastric cancer patients were reviewed retrospectively, and the differences in relationship indicators between the survival and death groups were compared and analyzed. The COX regression analysis and Kaplan–Meier Curve (K-M) were used to assess the prognostic significance of Fib combined with NLR in patients with gastric cancer.

Results

① The difference between the survival and death groups of patients with gastric cancer was statistically significant in the high and low Fib and NLR levels (X²=6.868 and 17.051, respectively, all P <0.01).② The correlation between Fib and NLR was remarkable (r=0.266, P=0.000).③ The F-NLR classifications showed statistically significant difference between the survival and death groups for gastric cancer patients (X²=20.200, P=0.000).④ Except for Fib and the middle/low classification of F-NLR, which was P<0.05, and the rest were all P<0.01. There was a substantial statistical difference between F-NLR classifications, Fib and NLR.⑤ F-NLR was found to be a predictive factor of death in patients with gastric cancer in COX regression analysis (P=0.000).⑥Patients with F-NLR scores of “0”, “1” and “2” had 5-year survival rates of 92.6%, 64.0% and 47.2%, respectively, and 3-year survival rates of 92.6%, 74.3% and 51.9%, respectively (all P=0.000).

Conclusion

The combination of Fib and NLR (F-NLR) improves the accuracy of prognosis in patients with gastric cancer.

Fibrinogen-Albumin Ratio as a New Promising Preoperative Biochemical Marker for Predicting Oncological Outcomes in Gastric Cancer: A Multi-institutional Study

BACKGROUND

The systemic inflammatory response caused by host-tumor interactions is currently recognized as a hallmark feature of cancer. No study has confirmed which systemic inflammatory factors can accurately predict the progression and long-term prognosis of gastric cancer (GC).

METHODS

Through the analysis of receiver operating characteristic curve (ROC), in the discovery cohort, a variety of indicators composed of usual inflammatory factors were compared. Fibrinogen-albumin ratio (FAR), which can accurately predict the long-term survival of GC patients was selected and was further verified in the test cohort and the external validation cohort.

RESULTS

The ROC curve analysis showed that the area under curve (AUC) value of FAR on the overall survival (OS) of GC patients was higher than that of other combined markers (P < 0.01). Patients in the high FAR group showed more advanced pathological stages, larger tumor diameters, and more poorly differentiated pathological type than those in the low FAR group (P < 0.05). Logistic regression analysis elucidated that, FAR was an independent risk factor for LN metastasis and tumor invasion of GC. High FAR was an independent risk factor for poor prognosis of GC patients. The relationship between FAR and pathological stage of GC and long-term prognosis of patients was verified in the test cohort and the external validation cohort with the same FAR cutoff value. The results are consistent with those of the discovery cohort.

CONCLUSIONS

As a new developed inflammation-related marker, FAR can independently and effectively predict the tumor burden and long-term prognosis of patients with advanced GC.

A nomogram combining plasma fibrinogen and systemic immune‑inflammation index predicts survival in patients with resectable gastric cancer

Hyperfibrinogenemia and cancer-associated systemic inflammatory response are strongly associated with cancer progression and prognosis. We aimed to develop a novel prognostic score (F-SII score) on the basis of preoperative fibrinogen (F) and systemic immunoinflammatory index (SII), and evaluate its predictive value in patients with resectable gastric cancer (GC). Patients diagnosed with GC between January 2012 and December 2016 were reviewed. The F-SII score was 2 for patients with a high fibrinogen level (≥ 3.37 g/L) and a high SII (≥ 372.8), whereas that for patients with one or neither was 1 or 0, respectively. A high F-SII score was significantly associated with older patient age, a high ASA score, large tumor size, large proportion of perineural invasion, and late TNM stage. Multivariate analysis indicated that the F-SII score, histological grade, and TNM stage were independent factors for overall survival (OS). The Harrell's concordance index (C-index) of a nomogram based on the F-SII score and several clinicopathological manifestations was 0.72, which showed a better predictive ability for OS than the TNM stage alone (0.68). In conclusion, preoperative F-SII may serve as a useful predictive factor for OS and refine outcome prediction for patients with resectable GC combined with traditional clinicopathological analysis.

Diagnostic and Prognostic Characteristics of Circulating Free DNA Methylation Detected by the Electrochemical Method in Malignant Tumors

Prior research has established an electrochemical method based on the differential adsorption capacity of gold surfaces with different methylated DNA degrees and found that this method might be valuable for cancer diagnosis by detecting circulating free DNA methylation. However, further investigation on the underlying mechanism and validation of its diagnostic and prognostic values in a large cohort of malignant tumors was limited. We found that DNA with different methylation levels formed particles of diverse sizes on the gold surface. Hydrophobic bonds played a significant role in the binding process of methylated DNA to the gold surface. The detection condition of an adsorption time of 10 min and temperature of 20 °C was optimal. In a large cohort of plasma samples from the patients with different malignant tumors, as well as normal individuals, we found that the electrochemical detection method based on the differential adsorption capacity of methylated DNA degree on a gold surface could be used as a noninvasive tool for malignant tumor diagnosis and prognostic evaluation. The diagnostic efficiency of this method in malignant tumors was even slightly better than that of the current tumor biomarkers widely used in routine clinical practice (circulating free DNA (cfDNA) vs. carcinoembryonic antigen (CEA), 0.8131 vs. 0.7191 and cfDNA vs. CA19-9, 0.7687 vs. 0.6693).

Aberrant Factors of Fibrinolysis and Coagulation in Pancreatic Cancer

Aberrant factors associated with fibrinolysis and thrombosis are found in many cancer patients, which can promote metastasis and are associated with poor prognosis. The relationship between tumor-associated fibrinolysis and thrombosis is poorly understood in pancreatic cancer. This review provides a brief highlight of existing studies that the fibrinolysis and coagulation systems were activated in pancreatic cancer patients, along with aberrant high concentrations of tissue plasminogen activator (t-PA), urine plasminogen activator (u-PA), D-dimer, fibrinogen, or platelets. These factors cooperate with each other, propelling tumor cell shedding, localization, adhesion to distant metastasis. The relationship between thrombosis or fibrinolysis and cancer immune escape is also investigated. In addition, the potential prevention and therapy strategies of pancreatic cancer targeting factors in fibrinolysis and coagulation systems are also been discussed, in which we highlight two effective agents aspirin and low-molecular weight heparin (LMWH). Summarily, this review provides new directions for the research and treatment of pancreatic cancer.

Prognostic Value of the Combined Index of Plasma Fibrinogen and the Neutrophil-Lymphocyte Ratio in Gastric Cancer

BACKGROUND

It has been reported that both fibrinogen and the neutrophil-lymphocyte ratio (NLR) are related to the degree of malignancy in various types of cancer. This study compared the combined index of fibrinogen and NLR (F-NLR) with NLR alone for predicting the prognosis of patients with resectable gastric cancer.

METHODS

We collected data on 666 patients with resectable gastric cancer. Patients were divided into three F-NLR score groups based on the following criteria: score 2, both hyperfibrinogenemia (≥350 mg/dl) and high NLR (≥2.5); score 1, either hyperfibrinogenemia or high NLR; and score 0, neither abnormality. The association between prognosis and NLR alone or F-NLR was evaluated using the Kaplan-Meier method and Cox multivariate analysis.

RESULTS

The high-NLR group had significantly worse overall survival (OS) than the low-NLR group (hazard ratio 1.62; 95% confidence interval [CI] 1.07-2.45; log-rank P = 0.022), but there was no significant difference between the high- and low-NLR groups after adjusting for the fibrinogen level. F-NLR groups showed significantly different OS (log-rank P < 0.001) and recurrence-free survival (log-rank P < 0.001). The 5-year OS rate for the groups with F-NLR scores of 2, 1, and 0 was 72.6%, 81.4%, and 90.4%, respectively. A Cox multivariate analysis of OS revealed that a high F-NLR score (1 or 2) was an independent prognostic factor (P = 0.007).

CONCLUSIONS

F-NLR was an independent prognostic factor in patients with gastric cancer and a more useful prognostic indicator than NLR alone.

The Prognostic Value of Combination of Plasma Fibrinogen and CA19-9 in Non-Distant Metastatic Breast Cancer Patients Undergoing Surgery

Purpose

This article aimed to study the prognostic value of preoperative plasma fibrinogen and CA19-9 in non-distant metastatic breast cancer (BC).

Patients and Methods

A total of 343 non-distant metastatic BC patients were included in this study. The optimal cut-off values of plasma fibrinogen and CA19-9 were obtained by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to evaluate prognostic factors for overall survival (OS). Survival data were assessed using Kaplan–Meier survival analysis with the Log-rank test. Based on the cut-off values, we classified the fibrinogen-CA19-9 score as follows: 2 (both hyperfibrinogenemia and high CA19-9), 1 (either hyperfibrinogenemia or high CA19-9), and 0 (neither hypefibrinogenemia nor high CA19-9).

Results

Our follow-up time totaled 10 years, the median follow-up time was 77 months (range=2–119 months), and 82 (23.9%) of 343 patients died during the follow-up period. The optimal cut-off values of plasma fibrinogen and CA19-9 were 2.805 g/L and 11.85 U/mL, respectively. The multivariate Cox analysis results suggested that there was a significant association between worse OS and elevated preoperative plasma fibrinogen and CA19-9 levels (HR=2.016, 95% CI=1.216–3.342, P=0.007; and HR=2.042, 95% CI=1.282–3.253, P=0.003). The area under the ROC curve (AUC) increased from 0.589 (for plasma fibrinogen) and 0.594 (for CA19-9) to 0.640 when these two parameters were combined. When we added this combined factor to the multivariate analysis, it was an independent prognostic factor for BC (P<0.001). According to the above results, we chose four prognostic factors to construct our nomogram. The AUC was 0.724, which indicates that the nomogram performs well.

Conclusion

The combination of plasma fibrinogen and CA19-9 could be used as a valid independent prognostic factor for non-distant metastatic BC compared with either parameter alone and could easily be applied in clinical practice.

Epidermal growth factor-like domain multiple 6 (EGFL6) promotes the migration and invasion of gastric cancer cells by inducing epithelial-mesenchymal transition

Epidermal growth factor-like domain multiple 6 (EGFL6) is implicated in tumor growth, metastasis and angiogenesis, and its ectopic alteration has been detected in aggressive malignancies. However, the pathophysiologic roles and molecular mechanisms of EGFL6 in gastric cancer (GC) remain to be elucidated. In this study, we investigated EGFL6 expression in GC cell lines and tissues using western blotting and immunohistochemistry. We found that EGFL6 was elevated expression in GC cell lines and tissues. The high expression of EGFL6 significantly was correlated with histological grade, depth of invasion, lymph node involvement, distant metastasis and TNM stage in GC and predicted poorer prognosis, and it could act an independent prognostic factor for GC patients. EGFL6 enhanced the proliferation, migration and invasion of GC cells. In addition, we identified the possible molecular mechanisms of EGFL6-involved epithelial-mesenchymal transition (EMT). EGFL6 regulated EMT process and induced metastasis partly through FAK/PI3K/AKT/mTOR, Notch and MAPK signaling pathways. In conclusion, EGFL6 confers an oncogenic function in GC progression and may be proposed as a potential therapeutic target for GC.

A Predictive Scoring System Based on Inflammatory and Tumor Markers for Gastric Cancer Patients Undergoing Curative Resection

Purpose

Inflammation is closely associated with prognosis in gastric cancer (GC). We aimed to assess the predictive value of existing inflammatory and tumor markers in GC, to establish a systemic score based on valuable predictors for early risk stratification of patients, and to create a nomogram for individual risk prediction.

Patients and Methods

We retrospectively analyzed 401 GC patients who underwent curative gastrectomy from 2007 to 2016.

Results

Through univariate and multivariate survival analysis, age (>60 years), depth of invasion (pT3–4), lymph node invasion (pN1–3), histologic classification (poor), adjuvant chemotherapy (no), albumin fibrinogen ratio (AFR) (<13.33), and carbohydrate antigen 19-9 (CA19-9) (>27 U/mL) independently indicated inferior disease-free survival (DFS). In addition, depth of invasion, lymph node invasion, histologic classification, adjuvant chemotherapy, AFR, and CA19-9 were incorporated in the prediction of cancer-specific survival (CSS). A combined AFR and CA19-9 prognostic score (CACPS) was established. Lower AFR (<13.33) and higher CA19-9 (>27 U/mL) were allocated 1 point each in the CACPS (range, 0–2). CACPS can be used as an independent predictor for DFS and CSS in multivariate analysis (for DFS: CACPS 1: HR=2.039, 95% CI: 1.357–3.065, P=0.001; CACPS 2: HR=2.419, 95% CI: 1.397–4.186, P=0.002; for CSS: CACPS 1: HR=2.035, 95% CI: 1.292–3.205, P=0.002; CACPS 2: HR=2.255, 95% CI: 1.252–4.059, P=0.007), with a higher CACPS indicating poor survival according to Kaplan–Meier curves (both P<0.001). Moreover, a nomogram for DFS and CSS was generated using the significant characteristics in the multivariate analysis, which exhibited high accuracy (for DFS: C-index=0.743, 95% CI: 0.698–0.788; for CSS: C-index=0.766, 95% CI: 0.718–0.814) versus tumor–node–metastasis staging (for DFS: C-index=0.692, 95% CI: 0.650–0.734; for CSS: C-index=0.720, 95% CI: 0.675–0.764).

Conclusion

Preoperative CACPS exhibited high accuracy in predicting prognosis for GC patients who underwent curative resection.

Clinicopathological and prognostic value of preoperative plasma fibrinogen in gastric cancer patients: A meta-analysis

BACKGROUND

Increasing evidence has revealed that plasma fibrinogen may serve as a prognostic indicator in multiple malignancies. However, there have been some conflicting findings on the prognostic value of plasma fibrinogen in gastric cancer (GC). We conducted a meta-analysis to explore the correlation between plasma fibrinogen and clinic outcome in GC.

METHODS

A comprehensive literature search was conducted using the Embase, the Web of Science, the Cochrane library, and PubMed databases. Combined hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to investigate the impact of elevated plasma fibrinogen on the prognosis and clinicopathological features of patients with GC.

RESULTS

A total of 11 studies involving 8315 patients were selected for this meta-analysis. The pooled results suggested that elevated plasma fibrinogen in GC patients was related to worse overall survival (OS) (HR = 1.57, 95% CI: 1.36-1.81, P < .001) and recurrence-free survival (RFS) (HR = 2.54; 95% CI: 1.19-5.41, P = .016). Additionally, a high level of fibrinogen was closely correlated with advanced tumor stage (OR = 2.14, 95% CI: 1.83-2.50, P < .001), lymph node metastasis (OR = 1.81, 95% CI: 1.56-2.11, P < .001), distant metastasis (OR = 1.48, 95% CI: 1.12-1.94, P = .005), deeper tumor invasion (OR = 2.25, 95% CI: 1.47-3.45, P < .001) and high carcinoembryonic antigen (OR = 1.41, 95% CI: 1.18-1.68, P < .001). However, there was no significant association between plasma fibrinogen and the differentiation grade (OR = 1.00, 95% CI: 0.86-1.17, P = .967). The Egger regression test indicated evidence of publication bias for OS.

CONCLUSION

Elevated plasma fibrinogen could be a potential predictor for worse OS and RFS in GC patients and a significant risk factor associated with aggressive clinical features.

Prognostic value of the fibrinogen-to-platelet ratio as an inflammatory and coagulative index in patients with gastric cancer

PURPOSE

We assessed the prognostic value of the fibrinogen-to-platelet ratio (FPR) as an inflammatory and coagulative index by examining its clinicopathologic and prognostic efficiency in patients with gastric cancer (GC).

METHODS

The subjects of this retrospective study were 182 GC patients whose FPR was measured preoperatively between January, 2001 and December, 2006. The FPR was defined as the plasma fibrinogen divided by the platelet counts.

RESULTS

Patients aged ≥ 65 years and with venous invasion had a significantly higher FPR (p = 0.02 and p < 0.01, respectively) than those aged < 65 years and without venous invasion. We found a correlation between the FPR and all recurrences (p < 0.01). Patients with a low FPR had significantly better overall survival (OS) and relapse-free survival (RFS) rates than patients with a high FPR (p = 0.001 for both). Furthermore, the FPR was an independent predictor of OS and RFS (p = 0.02 and 0.001, respectively), but the fibrinogen level was not. In a subgroup analysis, the FPR was a significant prognostic factor for OS and RFS in patients with pathological stages II/III disease and in patients aged < 65 years.

CONCLUSION

The FPR can be calculated easily and is more useful than the fibrinogen level for predicting the prognosis of GC patients. Patients with a high FPR, particularly those with undifferentiated tumors, those with pStage II/III disease, and those aged < 65 years, require more intensive chemotherapy.

Prognostic significance of pretreatment plasma fibrinogen level in patients with digestive system tumors: a meta-analysis

High pretreatment levels of plasma fibrinogen have been widely reported to be a potential predictor of prognosis in digestive system tumors; however, the conclusions are not consistent. Therefore, we performed a meta-analysis to comprehensively assess the prognostic roles of high pretreatment plasma fibrinogen levels in digestive system tumors. We searched for eligible studies in the PubMed, Embase, and Web of Science electronic databases for publications from the database inception to 1 September 2017. The endpoints of interest included overall survival, disease-free survival, and recurrence-free survival. We investigated the relationship between fibrinogenemia and overall survival in colorectal cancer (10 studies), gastric cancer (6), pancreatic cancer (6), hepatocellular carcinoma (7), and esophageal squamous cell carcinoma (10); the pooled results indicated that fibrinogenemia was significantly related to a worse overall survival (hazard ratio (HR) 1.73; 95% confidence interval (CI) 1.52, 1.97; P <0.001; HR 1.71; 95% CI 1.28, 2.28; P <0.001; HR 1.57; 95% CI 1.13, 2.17; P = 0.007; HR 1.89; 95% CI 1.57, 2.27; P <0.001, and HR 1.67; 95% CI 1.35, 2.07; P <0.001). Taken together, an increased pretreatment plasma fibrinogen level was related to worse survival in digestive system tumors, indicating that it could be a useful prognostic marker in these types of tumors.

Prognostic significance of combined preoperative fibrinogen and CA199 in gallbladder cancer patients

AIM

To investigate the prognostic value of the combination of preoperative plasma fibrinogen and CA199 in patients with gallbladder carcinoma (GBC).

METHODS

The clinicopathological data of 154 GBC patients were retrospectively reviewed after surgery. A receiver operating characteristic (ROC) curve was plotted to verify the optimum cut-off values for plasma fibrinogen and CA199. Univariate and multivariate survival analyses were performed to identify the factors associated with GBC prognosis. Based on the HRs calculated via multivariate survival analyses, patients with elevated plasma fibrinogen and CA199 levels were allocated a score of 2.1; those with an elevated plasma fibrinogen level only were allocated a score of 1, those with an elevated CA199 level only were allocated a score of 1.1, and those with neither of these abnormalities were allocated a score of 0.

RESULTS

ROC curve analysis showed that the optimum cut-off values for preoperative plasma fibrinogen and CA199 were 3.47 g/L and 25.45 U/mL, respectively. Multivariate analysis indicated that elevated preoperative plasma fibrinogen and CA199 levels were significantly correlated with worse overall survival (OS) (HR = 1.711, 95%CI: 1.114-2.627, P = 0.014, and HR = 1.842, 95%CI: 1.111-3.056, P = 0.018). When we combined these two parameters, the area under the ROC curve increased from 0.735 (for preoperative plasma fibrinogen only) and 0.729 (for preoperative CA199 only) to 0.765. When this combined variable was added to the multivariate analysis, the combination of plasma fibrinogen and CA199 (P < 0.001), resection margin (P < 0.001) and TNM stage (P = 0.010) were independent prognostic factors for GBC.

CONCLUSION

The combination of plasma fibrinogen and CA199 may serve as a more efficient independent prognostic biomarker for postoperative GBC patients than either parameter alone.

Using a nomogram based on preoperative serum fibrinogen levels to predict recurrence of papillary thyroid carcinoma

Background

Hyperfibrinogenemia is increasingly being recognized as an important risk factor related to cancer stage, development and outcomes. We evaluated whether preoperative serum fibrinogen levels predict recurrence of papillary thyroid carcinoma (PTC).

Methods

We retrospectively collected data for 1023 PTC patients who underwent surgery at our institution from Aug 2014 to Aug 2016. In total, 414 patients (from Aug 2014 to Dec 2015) were used as the training set to build the model, and 609 patients (from Jan 2016 to Aug 2016) were used as the testing set to validate the model.

Results

In the training set, PTC cases with high serum fibrinogen levels were more likely to have multiple PTCs (P = 0.001) and to exhibit surrounding tissue or organ invasion (both P < 0.01). Moreover, PTC patients with higher serum fibrinogen levels were also more likely to have an advanced tumor stage (T, P = 0.001) and distance metastasis (P < 0.001), and these patients had a significantly higher rate of postoperative PTC recurrence (P = 0.002). All of these findings were validated in the testing set. The results of univariate and multivariate analyses indicated that hyperfibrinogenemia was a risk factor for PTC recurrence. The identified risk factors were incorporated into a nomogram and validated using the testing set (C-index = 0.811, 95% CI: 0.762–0.871).

Conclusion

PTC cases with hyperfibrinogenemia are more likely to have an advanced TNM stage and have a higher rate of PTC recurrence. Our nomogram could be used to objectively and accurately predict PTC recurrence in a clinical setting.

A cumulative score based on preoperative fibrinogen and the neutrophil-lymphocyte ratio to predict outcomes in resectable gastric cancer

BACKGROUND

Recent studies have revealed that preoperative fibrinogen and the neutrophil-lymphocyte ratio (NLR) are associated with poor outcome in gastric cancer (GC). We aimed to evaluate whether the fibrinogen and the NLR score had a consistent prognostic value for resectable GC.

METHODS

We analyzed 1,293 consecutive patients who underwent curative surgery for GC. The F-NLR score was 2 for patients with hyperfibrinogenemia (>400 mg/dL) and elevated NLR (≥5.0), 1 for those with one abnormal index, and 0 for those with no abnormal indices.

RESULTS

We found that higher F-NLR scores were associated with larger tumor size, deeper tumor invasion and more lymph node metastasis (all P<0.05). In a multivariate analysis, F-NLR independently predicted postoperative survival (P<0.001). When stratified by tumor-node-metastasis (TNM) stage, the prognostic value of F-NLR was still maintained for stages I-II (P<0.001) and stage III (P=0.003). Of note, F-NLR also effectively stratified overall survival (OS) irrespective of age, adjuvant chemotherapy administration, tumor location and histological grade (all P<0.05). Furthermore, F-NLR and TNM stratified 5-year OS from 61% (F-NLR 0) to 15% (F-NLR 2) and from 92% (stage I) to 37% (stage III), respectively. Utilizing both F-NLR and TNM, 5-year OS ranged from 93% (F-NLR 0, TNM I) to 6% (F-NLR 2, TNM III).

CONCLUSION

The F-NLR score independently predicts outcomes in GC patients after curative surgery. Therefore, it should be implemented in routine clinical practice for identifying more high-risk patients.

Prognostic Impact of Change in the Fibrinogen and Albumin Score During Preoperative Treatment in Esophageal Cancer Patients

BACKGROUND

For resectable advanced esophageal cancer, a transthoracic esophagectomy following preoperative treatment is recognized as one of the standard treatments. Therefore, predictive markers which can be identified before surgery need to be established to identify patients with a poor prognosis.

METHODS

We retrospectively reviewed 102 consecutive patients who underwent curative transthoracic esophagectomy following preoperative treatment in our institution between 2004 and 2013. Based on plasma fibrinogen and serum albumin levels, the pretreatment and preoperative fibrinogen and albumin score (FA score) were investigated and the prognostic significance of the FA score change was compared with RECIST.

RESULTS

The patients were classified according to whether the FA score had remained unchanged or decreased (n = 77) or the FA score increased (n = 25). When the correlation between the response rate and change in the FA score was investigated, the response rate was significantly lower in the group with the increased FA score. In the survival analysis, patients in the increased FA score group exhibited a significantly worse recurrence-free survival (RFS) (P = 0.038). A multivariate analysis using the clinical stage and the change in the FA score as covariates revealed that a change in the FA score (HR 1.802; P = 0.047; 95% CI 1.008-3.221) was shown to be a significant independent predictive factor for RFS.

CONCLUSIONS

A change in the FA score was shown to be an independent prognostic factor for postoperative recurrence in esophageal cancer patients who have undergone transthoracic esophagectomy following preoperative treatment.

Presence of cancer cells in gastric lavage of gastric cancer patients as an indicator of advanced disease, predictor of tumour aggressive phenotype and independent prognostic factor for poor survival: The endoluminal metastatic pathway of gastric cancer and GL0/GL1 classification

OBJECTIVE

As of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; consequently, new methods of basic and advanced research have been proposed and tested. The presence (GL1) vs absence (GL0) of malignant cells exfoliated in gastric lavage (GL) of GC patients was formerly evaluated with diagnostic intent but not for staging or prognostic assessment. We investigated this hitherto unreported application of cytopathology.

METHODS

GL was preoperatively and prospectively collected from 80 GC patients and cytologically analysed. The results were compared with the classic clinicopathological features of GC and related to survival. The prognostic value of GL1 was assessed through univariate and multivariate analyses.

RESULTS

GL1 was detected in 36 samples (45%) and correlated with advanced tumour depth (T3-T4), lymphatic metastasis (N+), distant metastasis (M1) and lymphovascular invasion (LVI1; P=.0317, .0024, .003 and .0028, respectively). Overall survival (OS) was significantly shorter for GL1 (23 months) vs GL0 patients (42 months; P=.005) and GL1 vs GL0 T1 subjects (12.6 vs 47.8 months, P=.0029). Univariate analysis revealed that GL1, N+, M1, LVI1 and advanced stage were significantly associated with OS. Multivariate analysis assessed GL1 as the only independent prognostic factor for worse OS and progression-free survival (P=.0013 and .0107).

CONCLUSIONS

In the present study, GL1 was correlated with advanced disease, aggressive tumour behaviour and poor prognosis. Although additional studies are needed to confirm these findings, the GL0/GL1 classification can be applied to GC patients to achieve higher accuracy in staging, prognostic stratification and treatment selection.

C-reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

Multiple studies have reported the prognostic association of certain inflammatory factors with various types of cancer. The present study assessed the prognostic value of the C-reactive protein (CRP)/albumin (Alb) ratio and the neutrophil/lymphocyte ratio (NLR), separately and in combination, in gastric cancer (GC). A total of 337 cases pathologically diagnosed with gastric adenocarcinoma were retrospectively evaluated. The clinicopathological and prognostic relevance of the CRP/Alb ratio and NLR and their combination were analyzed. The optimal cut-off values of the CRP/Alb ratio and NLR were 0.38 and 3.14, respectively. High CRP/Alb ratio (≥0.38) and NLR (≥3.14) values were associated with increased tumor invasion, more distant metastasis and a more advanced tumor-node-metastasis stage (all P<0.05). In addition, a high NLR value was also associated with increased tumor size (P=0.02). The CRP/Alb ratio (≥0.38/<0.38) and NLR (≥3.14/<3.14) were independent prognostic factors for overall survival time (OS) in GC by multivariate analysis (P=0.005 and P=0.001). Using the CRP/Alb ratio and NLR classification, patients were stratified into three subgroups with different OS time (P<0.001), which were identified as independent prognostic variables in multivariate analysis (P<0.001). The present study demonstrated that the CRP/Alb ratio and NLR were independent prognostic factors for OS in patients with GC. The combination of these indexes was associated with significant prognostic value and may further stratify prognosis.

RAD51B as a potential biomarker for early detection and poor prognostic evaluation contributes to tumorigenesis of gastric cancer

Gastric cancer (GC) is a common and deadly disease worldwide. Outcomes of patients are poor largely due to chemoresistance or recurrence. Thus, identifying novel biomarkers to predict response to therapy and/or prognosis are urgently needed. RAD51B, a key player in DNA repair/recombination, has the potential to be a candidate oncogene and biomarker for cancer diagnosis and prognosis. However, its relationship with GC remains unclear. To evaluate clinicopathological and prognostic significance of RAD51B in GC, we examined messenger RNA (mRNA) and protein expression via quantitative real-time polymerase chain reaction (qRT-PCR) from 69 and tissue microarray from 144 GC patients, respectively. Our results showed that RAD51B mRNA expression was significantly up-regulated in tumors compared to that of matched noncancerous tissues (P < 0.001). In parallel, RAD51B protein showed a mainly nucleus-staining pattern, and the positive rate in tumors and stomach atypical hyperplasia was significantly higher than that in matched noncancerous tissues (P = 0.015). Moreover, high level of RAD51B protein was correlated with advanced stage (P = 0.009), aggressive differentiation (P = 0.022), and lymph node metastasis (P = 0.001). Further, Kaplan-Meier analysis indicated that patients with high level of RAD51B expression exhibited worse overall survival compared to patients with low level (P = 0.040). A multivariate Cox regression analysis suggested that RAD51B may be an independent prognostic factor for GC patients in Chinese population (P = 0.004). Additionally, functional studies indicated that over-expression of RAD51B promoted cell proliferation, aneuploidy, and drug resistance, while RAD51B knockdown led to G1 arrest and sensitized cells to 5-fluorouracil (5-FU). In conclusion, RAD51B may act as an oncogene during GC progression, and its hyper-expression may be a potential biomarker for early detection and poor prognosis of GC.