Clinical association between pre-treatment levels of plasma fibrinogen and bone metastatic burden in newly diagnosed prostate cancer patients

Abstract

Abstract Background: Due to the different treatments for low-volume metastatic prostate cancer (PCa) as well as high-volume ones, evaluation of bone metastatic status is clinically significant. In this study, we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients. Methods: A single-center retrospective analysis, focusing on prostate biopsies of newly diagnosed PCa patients, was performed. A total of 261 patients were enrolled in this study in a 4-year period. All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and, if present, the number of metastatic lesions would then be calculated. Clinical information such as age, prostate-specific antigen (PSA), fibrinogen, clinical T stage, and Gleason score were collected. Patients were divided into three groups: (i) a non-metastatic group, (ii) a high volume disease (HVD) group (>3 metastases with at least one lesion outside the spine), and (iii) a low volume disease (LVD) group (metastatic patients excluding HVD ones). The main statistical methods included non-parametric Mann-Whitney test, Spearman correlation, receiver operating characteristic (ROC) curves, and logistic regression. Results: Fibrinogen positively correlated with Gleason score (r\u200a=\u200a0.180, P\u200a=\u200a0.003), PSA levels (r\u200a=\u200a0.216, P\u200a<\u200a0.001), and number of metastatic lesions (r\u200a=\u200a0.296, P\u200a<\u200a0.001). Compared with the non-metastatic and LVD groups, the HVD group showed the highest PSA (104.98\u200ang/mL, median) and fibrinogen levels (3.39\u200ag/L, median), as well as the largest proportion of Gleason score >7 (86.8%). Both univariate (odds ratio [OR]\u200a=\u200a2.16, 95% confidential interval [CI]: 1.536–3.038, P\u200a<\u200a0.001) and multivariate (OR\u200a=\u200a1.726, 95% CI: 1.206–2.472, P\u200a=\u200a0.003) logistic regressions showed that fibrinogen was independently associated with HVD. The ROC curve suggested that fibrinogen acts as a predictor of HVD patients, yielding a cut-off of 3.08\u200ag/L, with a sensitivity of 0.684 and a specificity of 0.760 (area under the curve\u200a=\u200a0.739, 95% CI: 0.644–0.833, P\u200a<\u200a0.001). Conclusions: Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients. Our results indicate that fibrinogen might be a potential predictor of HVD.