Shuishen Zhang¹, Jianhua Fu² 

¹Department of ThoracicSurgery, the First Affiliated Hospital, Sun Yat-Sen University, ²Department of ThoracicOncology, Sun Yat-sen University Cancer Center

Objective:Increased serum fibrinogen has beenreported to be associated with tumor progression and a poor outcome in variouscarcinomas. However, the association between preoperative serum fibrinogen andprognosis has not been fully examined in esophageal cancer. Method: Preoperativeserum fibrinogen concentrations were examined in 1512 consecutive patients whounderwent esophagectomy between 2000 and 2008 by the Clauss method. The impactof fibrinogen on overall survival (OS) and disease-free survival (DFS) wasestimated using the Kaplan-Meier method and Cox proportional hazard models. Result:The serum fibrinogen concentration ranged from 1.5 to 8.0 g/L. A total 1067patients (70.6%) had normal serum fibrinogen concentration and 445 (29.4%) hadhyperfibrinogenemia (≥4g/L). Increased fibrinogen concentration significantlycorrelated with the status of weight loss (P<0.001), ever-smoking (P=0.001),alcohol consumption (P<0.001) and advanced pathological stage(P<0.001).Therewas strong evidence that patients with increased serum fibrinogen had moreunfavorable 5-year OS (35.1% VS 45.2%, P<0.001) and DFS (32.0% VS41.6%, P<0.001)when compared with normal fibrinogen concentration.Multivariate analysis showed that patients with high serum fibrinogenconcentration had a poor OS (HR [Hazard ratio] =1.20, 95%CI: 1.04-1.39, P=0.012)and DFS (HR [Hazard ratio] =1.18, 95%CI:1.03-1.36, P=0.019). Subgroupanalysis showed that the association with increased fibrinogen concentrationand poor OS (P<0.001) and DFS (P<0.001) was observed inpatients with esophageal squamous cell carcinoma (P<0.001). Conclusion:Preoperative serum fibrinogen was an independent prognostic factor forsurvival in esophageal cancer.

Key Words: fibrinogen  esophageal  cancer  overall survival