Pretreatment elevated fibrinogen level predicts worse oncologic outcomes in upper tract urothelial carcinoma  

作　　者：Hang Xu Jian-Zhong Ai Ping Tan Tian-Hai Lin Xi Jin Li-Na Gong Hao-Ran Lei Lu Yang Qiang Wei 

机构地区：[1]Department of Urology and Institute of Urology,West China Hospital,Sichuan University,Chengdu 610041,China

出　　处：《Asian Journal of Andrology》2020年第2期177-183,共7页亚洲男性学杂志（英文版）

基　　金：This program was supported by the National key Research and Development program of China(Grant No.SQ2017YFSF090096);the Prostate Cancer Foundation Young Investigator Award 2013,the National Natural Science Foundation of China(Grant No.81300627,No.81370855,No.81702536,and No.81770756);Programs from Science and Technology Department of Sichuan Province(Grant No.2018JY0089 and No.2017HH0063);Young Investigator Award of Sichuan University 2017(Grant No.2017SCU04A17).The funders had no role in patient selection,data extraction,statistical analysis or interpretation,writing of this article,or the decision to publish.

摘　　要：This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma(UTUC)in a large Chinese cohort.A total of 703 patients who underwent radical nephroureterectomy were retrospectively identified.Fibrinogen levels of≥4.025 g l?1 were defined as elevated.Logistic regression analysis was performed to determine the association between fibrinogen and adverse pathological features.Kaplan–Meier analysis and Cox regression models were used to assess the associations of fibrinogen with cancer-specific survival(CSS),disease recurrence-free survival(RFS),and overall survival(OS).Harrell c-index and decision curve analysis were used to assess the clinical utility of multivariate models.The median follow-up duration was 42(range:1–168)months.Logistic regression analysis revealed that elevated fibrinogen was associated with higher tumor stage and grade,lymph node involvement,lymphovascular invasion,sessile carcinoma,concomitant variant histology,and positive surgical margins(all P<0.05).Multivariate Cox regression analysis demonstrated that elevated fibrinogen was independently associated with decreased CSS(hazard ratio[HR]:2.33;P<0.001),RFS(HR:2.09;P<0.001),and OS(HR:2.09;P<0.001).The predictive accuracies of the multivariate models were improved by 3.2%,2.0%,and 2.8%for CSS,RFS,and OS,respectively,when fibrinogen was added.Decision curve analysis showed an added benefit for CSS prediction when fibrinogen was added to the model.Preoperative fibrinogen may be a strong independent predictor of worse oncologic outcomes in UTUC;therefore,it may be valuable to apply this marker to the current risk stratification in UTUC.

关 键 词：FIBRINOGEN prognosis RADICAL NEPHROURETERECTOMY upper TRACT UROTHELIAL carcinoma 

分 类 号：R737.1[医药卫生—肿瘤]