Clinicopathological and prognostic value of preoperative plasma fibrinogen in gastric cancer patients: A meta-analysis

BACKGROUND: Increasing evidence has revealed that plasma fibrinogen may serve as a prognostic indicator in multiple malignancies. However, there have been some conflicting findings on the prognostic value of plasma fibrinogen in gastric cancer (GC). We conducted a meta-analysis to explore the correlation between plasma fibrinogen and clinic outcome in GC. METHODS: A comprehensive literature search was conducted using the Embase, the Web of Science, the Cochrane library, and PubMed databases. Combined hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to investigate the impact of elevated plasma fibrinogen on the prognosis and clinicopathological features of patients with GC. RESULTS: A total of 11 studies involving 8315 patients were selected for this meta-analysis. The pooled results suggested that elevated plasma fibrinogen in GC patients was related to worse overall survival (OS) (HR = 1.57, 95% CI: 1.36–1.81, P < .001) and recurrence-free survival (RFS) (HR = 2.54; 95% CI: 1.19–5.41, P = .016). Additionally, a high level of fibrinogen was closely correlated with advanced tumor stage (OR = 2.14, 95% CI: 1.83–2.50, P < .001), lymph node metastasis (OR = 1.81, 95% CI: 1.56–2.11, P < .001), distant metastasis (OR = 1.48, 95% CI: 1.12–1.94, P = .005), deeper tumor invasion (OR = 2.25, 95% CI: 1.47–3.45, P < .001) and high carcinoembryonic antigen (OR = 1.41, 95% CI: 1.18–1.68, P < .001). However, there was no significant association between plasma fibrinogen and the differentiation grade (OR = 1.00, 95% CI: 0.86–1.17, P = .967). The Egger regression test indicated evidence of publication bias for OS. CONCLUSION: Elevated plasma fibrinogen could be a potential predictor for worse OS and RFS in GC patients and a significant risk factor associated with aggressive clinical features.