Prognostic significance of preoperative plasma fibrinogen levels in primary gastrointestinal stromal tumours: a retrospective cohort study

Abstract Background Improved prediction of prognosis for gastrointestinal stromal tumours (GIST) has become increasingly important since the introduction of small molecule tyrosine kinase inhibitors. Here, we aimed to evaluate the prognostic significance of preoperative plasma fibrinogen (Fib) levels in patients with primary GIST and to analyze their correlations with clinicopathological characteristics.Methods A total of 201 previously untreated patients with primary GIST who had underwent radical surgery at our institution between October 2004 and July 2018 were enrolled. Patient demographics, clinicopathological characteristics, preoperative plasma Fib levels and recurrence-free survival (RFS) were analyzed. The optimal cut-off value for Fib levels was calculated using receiver operating characteristic curve analysis. RFS, the primary endpoint, was calculated by the Kaplan–Meier method and compared by the log-rank test. Univariate and multivariate Cox regression models were calculated.Results Patients in high Fib group had a shorter RFS compared with low Fib group (P < 0.001). In multivariate analysis, high preoperative plasma Fib levels were detected as an independent adverse prognostic factor (P = 0.004, hazard ratio 3.443, 95% confidence interval 1.498‒7.916). Furthermore, high preoperative plasma Fib levels also indicated a poor prognosis within the modified National Institutes of Health (mNIH) high-risk subgroup (P = 0.013). In addition, preoperative plasma Fib levels were showed a positive correlation with several prognostic factors, and even linearly with tumour size (Spearman correlation coefficient [ r ] = 0.411, P < 0.001).Conclusions High preoperative plasma Fib levels may indicate a poor prognosis in patients with primary GIST. As a cost-effective biomarker, preoperative assessment of plasma Fib levels may help to further risk stratification for patients with mNIH high-risk GIST and instruct the application of target therapy.