We previously reported that fibrinogen (FNG) classification, which was based on the preoperative plasma FNG level (preop FNG) and change of FNG between pretreatment (preTx FNG) and preop FNG, could be a predictive marker of postoperative recurrence in esophageal cancer patients who received neoadjuvant chemotherapy (NAC). (Matsuda S, et al. Dis Esophagus. 2013). Currently, we conducted the follow up analysis in expanded data set and investigated the correlation with overall survival.
We retrospectively reviewed 178 patients who underwent transthoracic esophagectomy after NAC between 2000 and 2014. PreTx and preop FNG were confirmed in 132 patients. FNG classification was defined as previous report; based on preTx and preop FNG, patients in which FNG decreased during NAC and preop FNG < 350mg/dl was classified as Class A, either FNG increased during NAC or pre-op FNG > 350mg/dl as Class B, and both FNG increased and preop FNG > 350m/dl as Class C. The correlation between FNG classification, clinicopathological factors, recurrence free survival (RFS), and overall survival (OS) was investigated.
In 132 patients, distribution of pretreatment clinical stage was cStage I/II/III/IV of 21/34/70/7 respectively. The number of patients for each FNG classification Class A/B/C was 42/55/35. Tumor depth was significantly progressed in Class C (cT1/2/3/4, Class A 4/12/17/9, Class B 6/20/28/1, Class C 2/6/25/2. P = 0.007). In survival multivariate analysis in which cStage was used as a covariate, FNG classification was shown to be a predictive factor for RFS independent of cStage significantly (Class B: HR, 2.277; P = 0.018; Class C: HR, 2.498; P = 0.013). Regarding the OS, Class C was evaluated as a significant factor of poor survival (Class B: HR, 1.858; P = 0.106; Class C: HR, 2.307; P = 0.037).
FNG classification was shown to predict postoperative recurrence independent of cStage in this study. In order to confirm the benefit in the OS, further follow up is necessary. Fibrinogen is a popular indicator routinely measured in daily practice, FNG classification may be validate and feasible in esophageal cancer patients who received neoadjuvant chemotherapy.
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All authors have declared no conflicts of interest.