Background/aims: Preoperative chemoradiotherapy has become the current gold standard treatment for locally advanced rectal cancer. To date, no suitable prognostic markers could be used to identify rectal cancer patients who are most likely to experience a good outcome after preoperative chemoradiotherapy. The goal of this study was to evaluate whether serum fibrinogen level is suitable as a predictor of therapeutic response to preoperative chemoradiotherapy and prognosis for locally advanced rectal cancer.
Methodology: The study retrospectively analyzed the correlation between the pretherapeutic fibrinogen level and cancer response as well as prognosis in 53 patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy followed by surgery. Serum fibrinogen level more than 4.00g/L was defined as hyperfibrinogenemia.
Results: Of the 53 patients, thirty-four (64.2%) had a fibrinogen level less than or equal to 4g/L (hypofibrinogenemia) and the other 19 cases above 4g/L (hyperfibrinogenemia). Ten of the studied 53 patients (18.9%) had a pathologic complete response after preoperative chemoradiotherapy. The percentage of patients who experienced a pathological complete response was lower among patients with hyperfibrinogenemia than those with hypofibrinogenemia (5.3% vs. 26.5%). Concerning the survival, 68.4% (13/19) patients with hyperfibrinogenemia died of disease, while only 29.4% (10/34) in hypofibrinogenemia group. The Kaplan-Meier survival curves of patients with hypofibrinogenemia versus hyperfibrinogenemia showed a highly significant separation (p<0.05).
Conclusions: For locally advanced rectal cancer patients, pre-therapeutic fibrinogen level might be a useful predictor of prognosis, and it might also be used as a biomarker to predict the therapeutic response.