Establishing survival-prognosis of the individual patient is of uppermost interest, so there is intense focus on finding tumor-related prognostic factors to influence clinical decisions on operative treatment and the further therapeutic concept.1–3
Liposarcomas represent a spectrum of malignant tumors with adipocytic differentiation and are one of the most common subtypes of soft tissue sarcoma (STS). The 5-year survival rates are between 57 to 95%. The clinical presentation is versatile, appearing on all body parts, but cumulatively on extremities and the retroperitoneum and the course of the disease is difficult to predict. 4–7
The main histological subtypes are: atypical lipomatous tumor (ALT)/well differentiated liposarcoma, myxoid/round cell liposarcoma, dedifferentiated liposarcoma and pleomorphic liposarcoma. 4 The pathological subclassification and histologic grade are key prognostic factors for survival (Hannibal, Rutkowski): while ALT only carry a risk of local recurrence, the pleomorphic and dedifferentiated liposarcomas are high-grade malignancies with a substantial risk of metastatic disease. 4,7,8 Tumor size, depth, site, grade, age at diagnosis and resection margins have been associated with overall survival (OS) in STS. 6,7
In recent studies the concept of the involvement of systemic inflammation and acute phase proteins in cancer progression and metastasis has been postulated. Specifically, elevated preoperative CRP and neutrophil/lymphocyte (N/L) ratio as markers of systemic inflammatory response have been found to be associated with decreased overall survival in various cancers. 9–17
Furthermore, lower levels of serum albumin are considered to be an indicator of current systemic immune response to tumor cell products and inflammatory cytokines. Correspondingly, biomarkers of kidney dysfunction were identified to predict inpatient mortality. Elevated serum creatinine, low albumin, and a decreased albumin-creatinine ratio
(ACR) were found to be negative prognostic factor with worse disease specific survival in patients with myofibroblastic and fibroblastic sarcoma as well as liposarcoma. 18,19
Interestingly, also a link between certain proteins of haemostasis and tumor progression was evidenced in previous studies. 16, 20–22. C.A. et. al. showed that high D-dimer levels, as a biomarker indicating the activation of haemostasis and fibrinolysis, are associated with poor overall survival and increased mortality risk in cancer patients.23,24
In observational studies, fibrinogen, which is an essential protein for blood clot formation and also an acute phase protein, was described as an useful prognostic biomarker for several malignancies. 16,20,25,26
The impact of plasma levels of fibrinogen on risk of mortality and survival in patients with soft tissue sarcoma has been described, however, the value in association with liposarcoma has not yet been elucidated.
The aim of the present study was to investigate plasma levels of fibrinogen as a prognostic biomarker in patients with liposarcoma.