| Purpose: Gastric cancer has the highest incidence among all malignancies of the digestive system and is the second leading cause of cancer-related death worldwide.Recent years,the comprehensive treatment of radical D2 gastrectomy combined adjuvant chemotherapy or radiotherapy has been the main treatment modality for gastric cancer.Gastric cancer patients with stage Ⅰ and N0 generally have high survival rate after radical surgery,accurately predicting the overall outcomes for such patient population is difficult because of the relatively low incidence of relapse or metastasis for stage Ⅰ patients and the availability of only one prognostic indicator for node-negative patients.Furthermore,whether adjuvant chemotherapy has survival benefit for them remains unclear.As a type of easily accessible non-anatomical prognostic indicator,plasma fibrinogen concentration(PFC)has been demonstrated to be associated with tumorigenesis,angiogenesis,and hematogenous metastasis of malignant tumor cells.This study aimed to determine the prognostic value of preoperative plasma fibrinogen concentration in patients with stage Ⅰ-Ⅱ gastric cancer after curative gastrectomy particularly those with stage Ⅰ and T1-4a N0.Methods: The preoperative plasma fibrinogen concentration and clinicopathologic data of 793 patients with stage Ⅰ-Ⅱ gastric cancer who underwent curative gastrectomy were analyzed retrospectively.Plasma fibrinogen concentration(PFC)<4.0 g/L and ≧4.0 g/L were considered as PFC0 and PFC1,respectively.The association between PFC and the clinicopathological features of gastric cancer and the value of PFC in survival prediction were investigated.Results: PFC1 indicated poorer overall survival(OS)and cancer-specific survival(CSS)among patients with tumor-node-metastasis(TNM)stage Ⅰ-Ⅱ,and PFC was identified as an independent indicator of survival via multivariate analysis.Kaplan-Meier method analysis for the American Joint Committee on Cancer(AJCC)stages subdivided according to PFC level revealed a significantly worse prognosis of patients with PFC1 compared with those with PFC0 in the same AJCC stage.Importantly,PFC stage was proven to be an independent prognostic factor for stage Ⅰ and p T1-4a N0 gastric cancer.PFC stage combined with the AJCC-TNM staging has better accuracy for predicting disease prognosis than AJCC-TNM staging alone.Conclusion: The prognosis of patients with stage Ⅰ-Ⅱ gastric cancer can be further stratified by PFC level.For patients with stage Ⅰ or N0 gastric cancer,PFC1 can be considered a high-risk prognostic factor,and adjuvant chemotherapy should be recommended for patients with PFC1. |
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