Tumor Response and Survival in Patients with Advanced Non-Small-Cell Lung Cancer: The Predictive Value of Chemotherapy-Induced Changes in Fibrinogen

ABSTRACT Background Hyperfibrinogenemia is a common problem associated with various carcinomas. In advanced non-small-cell lung cancer (NSCLC), whether chemotherapy-induced changes in fibrinogen level relate to chemotherapeutic response and prognosis remains unclear. The purposes of this study were: (i) to analyze the correlation between the chemotherapy-induced changes of plasma fibrinogen level and the chemotherapeutic response after the first two courses of standard first-line platinum-based chemotherapy; and (ii) to evaluate the prognostic significance of the basal plasma fibrinogen level in patients with advanced NSCLC. Methods In this retrospective study, the data of 160 patients with advanced NSCLC in the First Hospital of China Medical University were collected and analyzed using SPSS software. Results The median pre-chemotherapy plasma fibrinogen level was 4.4 g/l.Pre-chemotherapy plasma fibrinogen levels correlated significantly with gender (P = 0.041) and age (P = 0.007). Post-chemotherapy plasma fibrinogen levels correlated with gender (P = 0.023), age (P = 0.004), ECOG (P = 0.002) and tumor response (P = 0.049). Plasma fibrinogen levels markedly decreased after chemotherapy in 98 (61.25%) patients with pre-chemotherapy hyperfibrinogenemia (P = 0.008); and in this population, there was a significant link between the decrease in fibrinogen level, and initial partial response (PR; P = 0.017) and stable disease (SD; P = 0.031). Univariate and multivariate analysis revealed that higher values of fibrinogen (more than 4.4 g/l) and ECOG 1 were positively associated with shorter overall survival (OS). Conclusions This study showed that a reduction in plasma fibrinogen levels induced by chemotherapy might be a promising biomarker for evaluating the efficacy of chemotherapy in advanced NSCLC. In addition, basal plasma fibrinogen levels could be used as an independent prognostic parameter for the overall survival of patients with advanced NSCLC.