Wang Zhan, Fan Hua, Wang Wenda, Zheng Guoyang, Xiao Yu, Guo Hao, Zhang Yushi
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
J Cancer. 2020 Feb 10;11(9):2401-2407. doi: 10.7150/jca.40961. eCollection 2020.
: This study aims to determine the relationship between preoperative plasma fibrinogen levels and the prognosis of patients with nonmetastatic renal cell carcinoma (RCC), including overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). : We retrospectively analysed the clinical data and prognostic information of 1194 nonmetastatic RCC patients who received radical nephrectomy or nephron-sparing surgery between 2005 and 2015 at our institution. Serum was collected for fibrinogen detection in the week prior to curative operation, and prognostic information was regularly collected by specially trained personnel. The cut-off value of the preoperative plasma fibrinogen level was defined by receiver operating characteristic (ROC) analysis. The chi-square test was used to analyse the association between preoperative fibrinogen level and clinical characteristics. Kaplan-Meier analysis was used to calculate survival curves, and significant differences were determined by the log-rank test. Other significant prognostic factors were evaluated by the Cox multivariate proportional hazard model. : The median follow-up period after radical or partial nephrectomy was 42.4 months (ranging from 0.433 to 146.37 months). The optimal preoperative plasma fibrinogen concentration was 3.975 g/L. The preoperative fibrinogen level was significantly associated with age, pathological T stage, sarcomatoid differentiation, necrosis and vein tumour thrombus (all p<0.05). High plasma fibrinogen levels were related to poor prognosis in terms of OS (p<0.001), CSS (p<0.001) and PFS (p<0.001). Multivariate analysis showed that the preoperative fibrinogen level remained an independent prognostic factor for OS (HR: 3.22, 95%CI: 1.87-5.55, p<0.001), CSS (HR: 4.12, 95%: 2.15-7.89, p<0.001) and PFS (HR: 3.137, 95%CI: 2.17-4.53, p<0.001). : High preoperative plasma fibrinogen level is an independent negative prognostic factor for OS, CSS and PFS in patients with non-metastatic RCC. Preoperative plasma fibrinogen could be an ideal indicator for evaluating the outcomes of postoperative patients with nonmetastatic RCC.
本研究旨在确定术前血浆纤维蛋白原水平与非转移性肾细胞癌（RCC）患者预后之间的关系，包括总生存期（OS）、癌症特异性生存期（CSS）和无进展生存期（PFS）。我们回顾性分析了2005年至2015年在我院接受根治性肾切除术或保留肾单位手术的1194例非转移性RCC患者的临床资料和预后信息。在根治性手术前一周采集血清用于纤维蛋白原检测，预后信息由经过专门培训的人员定期收集。术前血浆纤维蛋白原水平的临界值通过受试者工作特征（ROC）分析确定。采用卡方检验分析术前纤维蛋白原水平与临床特征之间的关联。采用Kaplan-Meier分析计算生存曲线，通过对数秩检验确定显著差异。通过Cox多因素比例风险模型评估其他显著的预后因素。根治性或部分肾切除术后的中位随访期为42.4个月（范围为0.433至146.37个月）。术前血浆纤维蛋白原的最佳浓度为3.975g/L。术前纤维蛋白原水平与年龄、病理T分期、肉瘤样分化、坏死和静脉瘤栓显著相关（均p<0.05）。高血浆纤维蛋白原水平在OS（p<0.001）、CSS（p<0.001）和PFS（p<0.001）方面与不良预后相关。多因素分析显示，术前纤维蛋白原水平仍然是OS（HR：3.22，95%CI：1.87-5.55，p<0.001）、CSS（HR：4.12，95%：2.15-7.89，p<0.001）和PFS（HR：3.137，95%CI：2.17-4.53，p<0.001）的独立预后因素。术前血浆纤维蛋白原水平高是非转移性RCC患者OS、CSS和PFS的独立负性预后因素。术前血浆纤维蛋白原可能是评估非转移性RCC术后患者预后的理想指标。
