The risk assessment of intraductal papillary mucinous neoplasms (IPMN) to either guide patients to surgical resection or watchful waiting is still under debate. Additional markers to better separate low and high-risk lesions would improve patient selection.
Patients who underwent pancreatic resections for IPMNs between January 2008 and December 2012 with available blood samples were selected and retrospectively assessed. Data on cyst characteristics such as cyst size, duct relation and main-duct dilatation were collected and plasma fibrinogen levels were measured.
A total of 73 patients fulfilled the inclusion criteria by pancreatic resection for pathologically confirmed IPMN and available blood sample. Histologically, IPMNs were classified as low-grade and borderline in 52 (71.2%, group 1) and as high-grade and invasive in 21 (28.8%, group 2) of all cases. Fibrinogen levels showed significant differences between the two groups (group 1: mean 3.62 g/L (SD ± 1.14); group 2: mean 4.49 g/L (SD ± 1.57); p = 0.027). A ROC-curve analysis calculated cut-off value of 4.71 g/L separated groups 1 and 2 (p = 0.008). Fibrinogen levels remained as the only significant factor in multivariable analysis, cyst size and duct relation were not significant.
Blood fibrinogen differed between low and high risk IPMNs and therefore, the use of fibrinogen as an additional discriminator in the pre-operative risk assessment of IPMNs should be further evaluated.
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- Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas.World J Gastrointest Oncol. 2014; 6: 311-324
- International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas.Pancreatology. 2012; 12: 183-197
- Precursor lesions for sporadic pancreatic cancer: PanIN, IPMN, and MCN.Biomed Res Int. 2014; 2014: 474905
- Utility of the sendai consensus guidelines for branch-duct intraductal papillary mucinous neoplasms: a systematic review.J Gastrointest Surg. 2014; 18: 1350-1357
- Prognostic significance of initial platelet counts and fibrinogen level in advanced non-small cell lung cancer.J Korean Med Sci. 2014; 29: 507-511
- Plasma fibrinogen levels and prognosis in patients with ovarian cancer: a multicenter study.Oncologist. 2009; 14: 979-985
- Cumulative prognostic scores based on plasma fibrinogen and serum albumin levels in esophageal cancer patients treated with transthoracic esophagectomy: comparison with the Glasgow prognostic score.Ann Surg Oncol. 2015; 22: 302-310
- Hyperfibrinogenemia is associated with lymphatic as well as hematogenous metastasis and worse clinical outcome in T2 gastric cancer.BMC Cancer. 2006; 6: 147
- The role of fibrinogen as a predictor in preoperative chemoradiation for rectal cancer.Ann Surg Oncol. 2015; 22: 209-215
- Preoperative plasma hyperfibrinogenemia is predictive of poor prognosis in patients with nonmetastatic colon cancer.Ann Surg Oncol. 2013; 20: 2908-2913
- Prognostic role of pretreatment plasma fibrinogen in patients with solid tumors: a systematic review and meta-analysis.Cancer Treat Rev. 2015; 41: 960-970
- Rapid physiological coagulation method in determination of fibrinogen.Acta Haematol. 1957; 17: 237-246
- Surgery for pancreatic cancer.Hematol Oncol Clin North Am. 2015; 29: 701-716
- Fibrinogen as a key regulator of inflammation in disease.Semin Immunopathol. 2012; 34: 43-62
- Role of systemic inflammatory response in predicting survival in patients with primary operable cancer.Future Oncol. 2010; 6: 149-163
- Inflammation and cancer: back to Virchow?.Lancet. 2001; 357: 539-545
- Cancer-related inflammation.Nature. 2008; 454: 436-444
- Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer.Int J Colorectal Dis. 2007; 22: 881-886
- The glasgow prognostic score as a predictor of survival in patients with potentially resectable pancreatic adenocarcinoma.Ann Surg Oncol. 2012; 19: 2917-2923
- Glasgow prognostic score predicts clinical outcomes in patients with pancreatic cancer undergoing adjuvant gemcitabine monotherapy after curative surgery.Anticancer Res. 2015; 35: 4865-4870
- Tumors and fibrinogen. The role of fibrinogen as an extracellular matrix protein.Ann N Y Acad Sci. 2001; 936: 406-425
- Pretreatment plasma fibrinogen level correlates with tumor progression and metastasis in patients with squamous cell carcinoma of the esophagus.J Gastroenterol Hepatol. 2007; 22: 2222-2227
- The clinical significance of preoperative plasma fibrinogen level and platelet count in resectable esophageal squamous cell carcinoma.World J Surg Oncol. 2015; 13: 157
- Detection of circulating pancreas epithelial cells in patients with pancreatic cystic lesions.Gastroenterology. 2014; 146: 647-651
- Circulating epithelial cells in patients with pancreatic lesions: clinical and pathologic findings.J Am Coll Surg. 2015; 221: 699-707
- Proposed nomogram predicting the individual risk of malignancy in the patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas.Ann Surg. 2016 Sep 6; ([Epub ahead of print])
Published online: January 16, 2017
Accepted: December 16, 2016
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.