Objectives: The objective of this retrospective study was to clarify the potential prognostic significance of pre-therapeutic fibrinogen levels in head and neck squamous cell carcinoma (HNSCC) patients treated with curative intent by primary radiotherapy (RT) or with postoperative radiotherapy (PORT).
Patients and methods: We retrospectively analyzed data from 347 patients with histologically confirmed locally advanced HNSCC. Analysis was conducted separately for the patient collective treated with PORT (N = 141; 85.1 % AJCC stage III/IV) and for patients treated with primary RT (N = 206; 97.1 % AJCC stage III/IV). Kaplan Meier analyses as well as univariate and multivariate survival analyses were performed to identify factors associated with overall survival (OS).
Results: The most relevant observation was that plasma fibrinogen levels were significantly associated with a reduction of overall survival rates. In the low-fibrinogen (below 411 mg/dL) postoperatively irradiated group, OS rates at 2 and 3 years were 86 and 83 %, and in the high-fibrinogen group 66 and 51 %, respectively. In the RT group with low fibrinogen levels, OS rates after 2 and 3 years were 74 and 53 %, and in the high-fibrinogen group 40 and 22 %, respectively. In multivariate analysis, elevated fibrinogen concentrations were associated with inferior OS in both the postoperatively (HR = 2.5; p = 0.001) as well as in the primarily irradiated (HR = 1.7; p = 0.003) group.
Conclusions: We conclude from these results that elevated pre-therapeutic fibrinogen may serve as a biomarker associated with worsened prognosis in locally advanced head and neck cancer patients treated by either RT or surgery followed by adjuvant radiotherapy.
Keywords: Biomarker; Fibrinogen; Head and neck cancer; Prognosis; Radiotherapy.