Article Abstract

Plasma fibrinogen as prognostic predictor in patients with metastatic renal cell carcinoma receiving target therapy

Authors: Lihe Wang, Wen Cai, Wen Kong, Jin Zhang, Yonghui Chen, Jiwei Huang, Yiran Huang


Background: The purpose of this work was to detect the influence of plasma fibrinogen level on the prognosis of patients with metastatic renal cell carcinoma (mRCC) before treatment of targeted therapy.
Methods: We identified mRCC patients who received first-line therapy of sorafenib or sunitinib between January 2006 to December 2016 in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Kaplan-Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS); log-rank test was used to compare the survival outcomes between patients with low and high fibrinogen level; and cox proportional hazard regression model was used to estimate the prognostic value. Prognostic accuracy was determined using Harrell concordance index (C-index) and receiver operating curve (ROC) analysis.
Results: Patients with high fibrinogen level both had significantly shorter median PFS (6 vs. 15 months, P<0.001) and OS (17 vs. 44 months, P<0.001) than those with low fibrinogen level. Multivariate analysis showed that pretreatment plasma fibrinogen was an independent predictor of PFS (HR 2.873, P<0.001) and OS (HR 3.213, P<0.001). The model built by the addition of fibrinogen improved predictive accuracy of PFS and OS compared with the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model [Harrell C-index: 0.74 and 0.76, AUC (area under the ROC curve): 0.863, P<0.001].
Conclusions: High pretreatment plasma fibrinogen could be a significant risk factor for mRCC patients receiving target therapy and increase the prognostic accuracy of established prognostic model.