Skip to main content

Advertisement

SpringerLink
Log in

The Role of Fibrinogen as a Predictor in Preoperative Chemoradiation for Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To perform chemoradiotherapy (CRT) effectively, it is clinically beneficial to identify predictors of tumor response after CRT. This study examined the association between plasma fibrinogen level before preoperative CRT and tumor response in advanced rectal cancer.

Methods

This was a retrospective study of 947 patients who received preoperative CRT followed by curative surgery for primary rectal cancer. We analyzed clinical factors that could be associated with pathologic tumor response in terms of downstaging (ypStage 0-I), primary tumor regression (ypT0-1), and complete response (ypT0N0).

Results

Downstaging was observed in 366 patients (38.6%), primary tumor regression in 187 patients (19.7%) and complete response in 138 patients (14.6%). Multivariate analysis found that pre-CRT carcinoembryonic antigen (CEA) level, fibrinogen level, hemoglobin level, clinical T and N classification, distance from anal verge, and histologic grade were significant predictive factors for downstaging; CEA level, fibrinogen level, and N classification predicted primary tumor regression; CEA level, and fibrinogen level were predictive for complete response.

Conclusions

This study demonstrated that fibrinogen level was a significant predictor of pathologic tumor response after preoperative CRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Page RC, Schroeder HE. Pathogenesis of inflammatory periodontal disease. A summary of current work. Lab Invest. 1976;34(3):235-49.

    CAS  PubMed  Google Scholar 

  2. Nand S, Messmore H. Hemostasis in malignancy. Am J Hematol. 1990;35(1):45–55.

    Article  CAS  PubMed  Google Scholar 

  3. Oya M, Akiyama Y, Okuyama T, Ishikawa H. High preoperative plasma D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer. Jpn J Clin Oncol. 2001;31(8):388–94.

    Article  CAS  PubMed  Google Scholar 

  4. Yamashita H, Kitayama J, Taguri M, Nagawa H. Effect of preoperative hyperfibrinogenemia on recurrence of colorectal cancer without a systemic inflammatory response. World J Surg. 2009;33(6):1298–305.

    Article  PubMed  Google Scholar 

  5. Son HJ, Park JW, Chang HJ, et al. Preoperative plasma hyperfibrinogenemia is predictive of poor prognosis in patients with nonmetastatic colon cancer. Ann Surg Oncol. 2013;20(9):2908–13.

    Article  PubMed  Google Scholar 

  6. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  7. Ha YH, Jeong S, Lim S, et al. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg. 252(2):336–40.

    Article  Google Scholar 

  8. Kim TH, Chang HJ, Kim DY, et al. Pathologic nodal classification is the most discriminating prognostic factor for disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Int J Radiat Oncol Biol Phys. 2010;77(4):1158–65.

    Article  PubMed  Google Scholar 

  9. Kim DY, Jung KH, Kim TH, et al. Comparison of 5-fluorouracil/leucovorin and capecitabine in preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2007;67(2):378–84.

    Article  CAS  PubMed  Google Scholar 

  10. Rdel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23(34):8688–96.

    Article  Google Scholar 

  11. Clauss A. Rapid physiological coagulation method in determination of fibrinogen. Acta Haematol. 1957;17(4):237-46.

    Article  CAS  PubMed  Google Scholar 

  12. Yoon SM, Kim DY, Kim TH, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007;69(4):1167–72.

    Article  PubMed  Google Scholar 

  13. Fu CG, Tominaga O, Nagawa H, et al. Role of p53 and p21/WAF1 detection in patient selection for preoperative radiotherapy in rectal cancer patients. Dis Colon Rectum. 1998;41(1):68–74.

    Article  CAS  PubMed  Google Scholar 

  14. Kikuchi M, Mikami T, Sato T, et al. High Ki67, Bax, and thymidylate synthase expression well correlates with response to chemoradiation therapy in locally advanced rectal cancers: proposal of a logistic model for prediction. Br J Cancer. 2009;101(1):116–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Park JW, Lim SB, Kim DY, et al. Carcinoembryonic antigen as a predictor of pathologic response and a prognostic factor in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and surgery. Int J Radiat Oncol Biol Phys. 2009;74(3):810–7.

    Article  PubMed  Google Scholar 

  16. Palumbo JS, Kombrinck KW, Drew AF, et al. Fibrinogen is an important determinant of the metastatic potential of circulating tumor cells. Blood. 2000;96(10):3302–9.

    CAS  PubMed  Google Scholar 

  17. Camerer E, Qazi A, Duong DN, Cornelissen I, Advincula R, Coughlin SR. Platelets, protease-activated receptors, and fibrinogen in hematogenous metastasis. Blood. 2004;104(2):397–401.

    Article  CAS  PubMed  Google Scholar 

  18. Akakura N, Hoogland C, Takada YK, et al. The COOH-terminal globular domain of fibrinogen gamma chain suppresses angiogenesis and tumor growth. Cancer Res. 2006;66(19):9691–7.

    Article  CAS  PubMed  Google Scholar 

  19. Kawai K, Kitayama J, Tsuno NH, et al. Hyperfibrinogenemia after preoperative chemoradiotherapy predicts poor response and poor prognosis in rectal cancer. Int J Colorectal Dis. 2011;26:45–51.

    Article  PubMed  Google Scholar 

  20. Lee NK, Kim DY, Kim SY, et al. Clinical outcomes of local excision following preoperative chemoradiotherapy for locally advanced rectal cancer. Cancer Res Treatment. 2014;46(2):158–164.

    Article  Google Scholar 

  21. Shin A, Kim KZ, Jung KW, et al. Increasing trend of colorectal cancer incidence in Korea, 1999-2009. Cancer Res Treatment. 2012;44(4):219–26.

    Article  Google Scholar 

  22. Wenger RH, Rolfs A, Marti HH, Bauer C, Gassmann M. Hypoxia, a novel inducer of acute phase gene expression in a human hepatoma cell line. J Biol Chem. 1995;270(46):27865–70.

    Article  CAS  PubMed  Google Scholar 

  23. Lawrence SO, Simpson-Haidaris PJ. Regulated de novo biosynthesis of fibrinogen in extrahepatic epithelial cells in response to inflammation. Thromb Haemost. 2004;92(2):234–243.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by the National Cancer Center Grant (NCC-1310070).

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

DYK contributed in patient accrual, participated in study design, and gave final approval of the manuscript to be published. JHL and JHH contributed in data collection, performed statistical analysis and drafted the manuscript. BCY contributed in design and coordination of the study. HJC, JWP, JHO, DKS, SYK, and THK contributed in patient accrual. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea

    Jong Hoon Lee MD, Jong Hee Hyun MD, Dae Yong Kim MD, Ji Won Park MD, Sun Young Kim MD, Hee Jin Chang MD, Byung Chang Kim MD, Tae Hyun Kim MD, Jae Hwan Oh MD & Dae Kyung Sohn MD

  2. Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Jong Hoon Lee MD

  3. Colorectal Cancer Branch, Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea

    Byong Chul Yoo PhD

Authors
  1. Jong Hoon Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jong Hee Hyun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dae Yong Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byong Chul Yoo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji Won Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sun Young Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hee Jin Chang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Byung Chang Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tae Hyun Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jae Hwan Oh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Dae Kyung Sohn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dae Yong Kim MD.

Additional information

J. H. Lee and J. H. Hyun contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.H., Hyun, J.H., Kim, D.Y. et al. The Role of Fibrinogen as a Predictor in Preoperative Chemoradiation for Rectal Cancer. Ann Surg Oncol 22, 209–215 (2015). https://doi.org/10.1245/s10434-014-3962-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3962-5

Keywords

Search

Navigation