Hu Wenjing, Zheng Chen, Quan Ruida, Dai Xuanxuan, Zhang Xiaohua
Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Cancer Manag Res. 2020 Sep 23;12:8875-8886. doi: 10.2147/CMAR.S270385. eCollection 2020.
This article aimed to study the prognostic value of preoperative plasma fibrinogen and CA19-9 in non-distant metastatic breast cancer (BC).
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).
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, =0.007; and HR=2.042, 95% CI=1.282-3.253, =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 (<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.
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.
本文旨在研究术前血浆纤维蛋白原和CA19 - 9在非远处转移性乳腺癌（BC）中的预后价值。
本研究共纳入343例非远处转移性BC患者。通过受试者工作特征（ROC）曲线分析获得血浆纤维蛋白原和CA19 - 9的最佳临界值。采用单因素和多因素Cox回归分析评估总生存期（OS）的预后因素。生存数据采用Kaplan - Meier生存分析和对数秩检验进行评估。根据临界值，我们将纤维蛋白原 - CA19 - 9评分分为以下几类：2（高纤维蛋白原血症和高CA19 - 9均存在）、1（高纤维蛋白原血症或高CA19 - 9二者其一）和0（高纤维蛋白原血症和高CA19 - 9均不存在）。
我们的随访时间共计10年，中位随访时间为77个月（范围 = 2 - 119个月），343例患者中有82例（23.9%）在随访期间死亡。血浆纤维蛋白原和CA19 - 9的最佳临界值分别为2.805 g/L和11.85 U/mL。多因素Cox分析结果表明，术前血浆纤维蛋白原和CA19 - 9水平升高与较差的OS显著相关（HR = 2.016，95%CI = 1.216 - 3.342，P = 0.007；HR = 2.042，95%CI = 1.282 - 3.253，P = 0.003）。当这两个参数联合时，ROC曲线下面积（AUC）从0.589（血浆纤维蛋白原）和0.594（CA19 - 9）增加到0.640。当我们将这个联合因素加入多因素分析时，它是BC的独立预后因素（P < 0.001）。根据上述结果，我们选择四个预后因素构建我们的列线图。AUC为0.724，这表明列线图表现良好。
与单独的任何一个参数相比，血浆纤维蛋白原和CA19 - 9的联合可作为非远处转移性BC的有效独立预后因素，并且可以很容易地应用于临床实践。
