| Objective: The incidence of Gastric Cancer(GC)in our country is very high,ranked the second in male and third in female,and easily occur liver metastasis in early stage.Previous study have shown that hyperfibrinogenemia before operation can predict advanced tumor,depth of tumor invasion,lymph node metastasis and large tumor size and effect the overall survival.The studies which discover the relationship between the level of plasma fibrinogen and GC are rarely reported in our country.This report aim to discuss the correlation between plasma fibrinogen level and clinicopathological factors in patients suffered from Gastric Cancer with Liver Metastasis and to evaluate the value of predict efficacy and prognosis so that we can provide the reference for clinical treatment.Methods: Retrospectively collected the medical records and follow-up data of patients with GC from January 2010 to December 2014 at General Surgery Department of the Fourth Hospital of Hebei Medical University.The blood routine examination,liver and kidney function test,blood coagulation function and the tumor makers were measured a week before treatment by our hospital laboratory who give us the accurate results.Statistical analysis was carried out by SPSS 13.0 so that we can detect the association between plasma fibrinogen level and clinicopathological factors in Liver Metastasis patients,measure the value of predict efficacy and prognosis.Results:1 A total of 437 patients suffered from GC were enrolled in our study.Among them,there were 248 cases to accept radical gastrectomy and 189 patients because of Liver Metastasis failling to have operation.The means±SD of plasma fibrinogen level in early stage people was 3.28±1.06g/L as well as 3.70±1.02g/L in Liver Metastasis cases,T-Test showed that fibrinogen levels were higher in Liver Metastasis group compare with the early stage one.Further statistical analysis showed that the incidence of hyerfibrinogenemia is also higher(20.63% vs.8.87%;P<0.001)in Liver Metastasis patients.2 Further statistical test found that in Liver Metastasis group,plasma fibrinogen level were higher in those patients with high inflammatory markers such as platelet counts(P=0.001),albumin level(P=0.010),platelet : lymphocyte ratios(P=0.018).In addition,in elder group there also had a increasing trend,however the difference between different sex or location did not have statistically significance(P>0.05).Otherwise,although the lesions,number in liver and liver function had some influence on fibrinogen level,the difference did not have statistically significance(P > 0.05).But the plasma fibrinogen level was higher in combined organ metastasis,celiac lymph nodes metastasis or distant lymph nodes metastasis(P<0.05),and maybe a good predictor to suggest disease stage.Interestingly,there was no relationship between tumor markers –CEA(P=0.710)?CA19-9(P=0.450)?CA72-4(P=0.40)?CA50(P=0.631)and fibrinogen.3 There were 51 cases have been collected the efficacy data among the 189 cases who suffered from Liver Metastasis.The number of partial remission(PR)patients was 17,as well as 34 cases who evaluated as stable disease(SD)or progressive disease(PD),unfortunately there had no complete remission(CR)patients.Among the total 17 remission cases,the level of plasma fibrinogen was significantly decrease after relevant treatment and the difference between them had statistically significance(P=0.011).By contrast,there had no statistically difference(P=0.476)between before and after treatment in no remission patients,but had a increasing trend after chemotheraphy.4 Among the total patients who had Liver Metastasis,there were 39 cases who had hyperfibrinogenemia before relavant treatment,the death number was 30 and the mortality was 76.92%.The plasma fibrinogen level in 150 cases were normal,with 119 cases of death,the death rate was 79.33%.However,the difference between them did not have statistically significance(P>0.05).Further survival analysis suggested that the survival rate also had no difference(Log-Rank test;P=0.829),but the overall survival(OS)had a declineing trend in patients who have hyperfibrinogenemia,which could predict worse clinical outcome.Conclusions: Our study suggested that the level of fibrinogen in Gastric Cancer with Liver Metastasis is significantly higher than the early stage cases,and this increase is closely related to many clinicopathological factors such as inflammatory markers,etc.As a sensitive blood biomarker to predict efficacy and worse clinical outcome,plasma fibrinogen level is economical,simple and practical which is benefit to our clinical work. |
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