The Prognostic Value of Preoperative Fibrinogen in Patients with Radical Cholecystectomy

Abstract

Background and Aims. There is currently a lack of suitable hematological markers as a complement to pathological factors in predicting the prognosis of patients with gallbladder cancer. The study aimed to investigate the clinical value of preoperative fibrinogen levels in assessing the prognosis of patients with gallbladder cancer after radical surgery. Methods. The study retrospectively analyzed 260 gallbladder cancer patients who underwent radical resection. Time-dependent receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and fibrinogen. Besides, univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed to determine independent markers in peripheral blood. Then, subgroup analyses of fibrinogen in different degrees of differentiation, age, gender, and BMI were performed by log-rank test. Result. The cut-off values of fibrinogen, CEA, and CA19-9 were set at 2.97 g/L, 2.17 ng/mL, and 41.1 U/mL, respectively. The results showed that the preoperative fibrinogen level was associated with tumor size, degree of differentiation, TNM stage, and CA19-9 levels. Multivariate analyses indicated that advanced TNM stage, excessive fibrinogen, CEA, and CA19-9 levels were independent risk factors for postoperative DFS. And gallbladder neck tumors, poor differentiation, cancer nodules, advanced TNM stage, excessive fibrinogen, and CEA levels were independent adverse factors for postoperative OS. Notably, the preoperative excessive fibrinogen was an independent adverse factor for both DFS ( $p=0.044$ , $\text{HR}=1.629$ , 95% $\text{CI}=1.014-2.618$ ) and OS ( $p=0.006$ , $\text{HR}=2.328$ , 95% $\text{CI}=1.272-4.261$ ) in patients with gallbladder cancer. The subgroup analyses further indicated that patients with high-level of fibrinogen had both poorer DFS ( $p=0.002$ ) and OS ( $p=0.005$ ) than patients with poorly-differentiated gallbladder cancer. And for well-differentiated gallbladder cancer, patients with high fibrinogen levels had poorer OS ( $p=0.004$ ), but no significant difference in DFS ( $p=0.062$ ). Besides, fibrinogen was more significant in GBC patients with higher BMI (>22.62) or older age (>60 yrs) and was not affected by gender. Conclusion. Elevated preoperative fibrinogen level was independently associated with poor postoperative DFS and OS in patients with gallbladder cancer, especially for poor differentiation.