Preoperative levels of plasma fibrinogen as a predictor for stage, optimal debulking, and platinum-resistance in epithelial ovarian carcinoma

Abstract

Objectives: This study was conducted to evaluate whether preoperative levels of fibrinogen, CA-125 and neutrophil to lymphocyte ratio (NLR) are predictive for FIGO stage, optimal debulking surgery and platinum resistance in epithelial ovarian cancer (EOC) patients.

Methods: Preoperative plasma levels of fibrinogen, CA-125 and neutrophil to lymphocyte ratio were retrospectively analyzed in patients with EOC who underwent primary cytoreductive surgery between January 2000 to December 2009. Clinico-pathologic characteristics including operative finding, FIGO stage, progression free interval after primary adjuvant chemotherapy and overall survival were evaluated. Response was evaluated with image using the RECIST criteria and serum CA-125 levels.

Results: Mean values of fibrinogen, CA-125 levels and NLR were significantly higher in patients with advanced FIGO stage and suboptimal debulking surgery. In advanced stage, suboptimal debulking surgery and high plasma fibrinogen levels correlated with platinum-resistance while CA-125 and NLR were statistically insignificant. Receiver operating characteristic curve showed the best cutoff values of fibrinogen levels for the prediction for platinum resistance (504.5≥mg/dl, sensitivity: 64.4%, specificity: 69.6%, positive predictive value=0.71, negative predictive value=0.64). In a log rank test, the high plasma fibrinogen levels and suboptimal debulking surgery showed poor prognosis for progression free interval and overall survival.

Conclusions: The preoperative fibrinogen levels are more useful to predict optimal debulking surgery and platinum resistance than CA-125 and NLR. The preoperative fibrinogen levels may be helpful to predict further prognosis.