ASO：纤维蛋白原可作为结肠癌患者的预后指征

在2013年4月25日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上，韩国国立癌症中心的Ji Won Park博士等人发文指出，一种感染指标-纤维蛋白原可作为结肠癌预后指征。包括全身性感染在内的宿主性因素可对结直肠癌结局产生影响。这项研究目的为，评价可作为感染缓解率指标的纤维蛋白原及感染相关评分对结肠癌的预后意义。

研究人员对非转移性结肠癌患者病历进行了回顾性考察，这些患者自2005年1月至2007年12月期间，曾接受过根治性切除治疗。在诊断时，研究人员对患者的纤维蛋白原、白蛋白、C反应蛋白、中性粒细胞、淋巴细胞及血小板计数进行了测量。并对患者术前血浆纤维蛋白原水平及临床病理特征间的联系进行了分析。最终通过单变量及多变量生存分析，对与患者无病生存率及总生存率相关的因素进行了鉴定。

共有624例接受根治性切除治疗的结肠癌患者符合该研究入选标准。患者术前血浆纤维蛋白原水平平均值为325.24 ± 88.19mg/dl。研究发现，较高水平的术前血浆纤维蛋白原与性别(男性)、老龄、低分化/粘液性肿瘤、晚期肿瘤、癌胚抗原(CEA)水平升高、较高的Glasgow预后评分值、较高的中性粒细胞：淋巴细胞比值及血小板：淋巴细胞比值有关。多变量分析表明，血浆纤维蛋白原水平升高[无病生存率:风险比(HR) 1.999, 95 %置信区间 (95 % CI) 1.081 -3.695, P = .027; 总生存率: HR 3.138,95 % CI 1.077-9.139, P = .036]、晚期肿瘤及较高的CEA水平与较差的无病生存率及总生存率独立相关。此外，感染相关评分均明显与生存率无关。

与结肠癌相关的拓展阅读：

• JCO：复旦大学许剑民等发现妥昔单抗联合化疗可有效改善部分结肠癌肝转移患者预后
• JCO:吸烟恶化结肠癌预后
• JBC：研究揭示Pax2在结肠癌中作用机制
• JCO：结肠癌患者久坐可增加死亡风险
• 腰臀比大的人患结肠癌风险增高
• Lancet Oncol：在晚期结肠癌患者中辅助应用贝伐单抗并无益处
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Preoperative Plasma Hyperfibrinogenemia is Predictive of Poor Prognosis in Patients with Nonmetastatic Colon Cancer.
BACKGROUND
The outcomes of colorectal cancer are determined by host factors, including systemic inflammation. The purpose of this study was to evaluate the prognostic significance of fibrinogen and inflammation-based scores, as markers of the inflammatory response, in colon cancer.
METHODS
We retrospectively reviewed the medical records of patients with nonmetastatic colon cancer who underwent curative resection between January 2005 and December 2007. Fibrinogen, albumin, C-reactive protein, neutrophil, lymphocyte, and platelet counts were measured at the time of diagnosis. Correlations between preoperative plasma fibrinogen levels and clinicopathologic characteristics were analyzed. Univariate and multivariate survival analyses were performed to identify factors associated with disease-free and overall survival.
RESULTS
A total of 624 patients who underwent curative resection for colon cancer were eligible for this study. Mean preoperative plasma fibrinogen levels were 325.24 ± 88.19 mg/dl. Higher preoperative plasma fibrinogen levels were associated with sex (male), old age, poorly/mucinous differentiated tumor, advanced tumor stage, elevated carcinoembryonic antigen (CEA) levels, higher modified Glasgow Prognostic Score, and higher neutrophil:lymphocyte and platelet:lymphocyte ratios. In multivariate analysis, elevated plasma fibrinogen level [disease-free survival: hazard ratio (HR) 1.999, 95 % confidence interval (95 % CI) 1.081-3.695, P = .027; overall survival: HR 3.138, 95 % CI 1.077-9.139, P = .036], advanced tumor stage, and higher CEA levels were independently associated with worse disease-free survival and overall survival. None of the inflammation-based scores were significantly associated with survival.
CONCLUSIONS
Fibrinogen as one of inflammatory markers may be considered a possible prognostic marker in colon cancer.