术前纤维蛋白原升高是预测胃癌不良预后的重要血清标志物

Elevated preoperative fibrinogen is an important serum predictive marker for poor prognosis of gastric cancer

目的探讨术前血清纤维蛋白原是否可作为胃癌预后预测的分子标志物。方法回顾性分析术前纤维蛋白原水平与胃癌患者临床病理特征之间的相关性,并对胃癌患者的无病生存期和总生存期进行单因素和多因素生存分析,筛选影响胃癌患者预后的独立的影响因素。结果 327例患者最终纳入本研究,33.9%(111/327)的胃癌患者术前诊断为纤维蛋白原升高;进一步分析显示,纤维蛋白原水平升高与胃癌患者的病理T分期(P<0.001)、病理N分期(P=0.004)以及病理TNM分期(P<0.001)相关,随着肿瘤分期的升高,患者纤维蛋白原水平随之升高;单因素生存分析显示,相较于纤维蛋白原正常的患者,术前高纤维蛋白原水平的胃癌患者显示了较差的无病生存期(21.6月对比43.0月,P<0.001),同样,纤维蛋白原高的患者总生存期只有23.6月,远低于纤维蛋白原正常患者的56.4月,P<0.001。多因素分析证实纤维蛋白原升高是患者拥有较差的无病生存期和总生存期的独立的影响因素。结论胃癌患者术前易发生高纤维蛋白原血症,且其高水平与胃癌患者的肿瘤浸润深度及淋巴结转移密切相关,高纤维蛋白原水平是胃癌患者预后不佳的独立的影响因素,提示纤维蛋白原可作为胃癌预后预测的潜在的血清标志物。

Objective This study intends to explore whether preoperative serum fibrinogen can be used as a molecular marker for predicting the prognosis of gastric cancer.Methods The correlation between preoperative fibrinogen levels and clinicopathological characteristics of gastric cancer patients was retrospectively analyzed.The disease-free survival(DFS)and overall survival(OS)of patients with gastric cancer were analyzed by univariate and multivariate survival analysis,Independent influencing factors that affect the prognosis of patients with gastric cancer was analyzed by Cox regression.Results 327 patients were finally included in this study.33.9%(111/327)of gastric cancer patients were diagnosed as hyperfibrinogenemia before surgery,further analysis showed that the elevated fibrinogen level was associated with the pathological T stage(P<0.001),pathological N stage(P=0.004)and pathological TNM stage(P<0.001)are related.As the tumor stage increases,the patient’s fibrinogen level increases;Moreover,univariate survival analysis shows that compared with In patients with normal fibrinogen,gastric cancer patients with preoperative high fibrinogen levels showed poor DFS(21.6 months vs.43.0 months,P<0.001).Similarly,patients with high fibrinogen had OS about 23.6 months,which was much lower than the 56.4 months of patients with normal level,P<0.001.In the end,multivariate analysis confirmed that elevated fibrinogen is an independent factor affecting DFS and OS of patients.Conclusion Patients with gastric cancer are prone to hyperfibrinogenemia before surgery,and its high level is closely related to the depth of tumor invasion(T stage)and lymph node metastasis(N stage)in patients with gastric cancer.High fibrinogen level is an independent influencing factor for the poor prognosis of patients with gastric cancer.Fibrinogen can be used as a potential serum marker for the prognosis of gastric cancer.