Background and Objective: Elevated plasma fibrinogen (FBG) level is associated with tumor progression and poor patient outcomes in several cancers. The aim of this study was to investigate the prognostic value of preoperative plasma FBG level in hepatocellular carcinoma (HCC) patients after liver transplantation (LT).

Methods: We analyzed the outcome of 96 patients who underwent LT for HCC at our institution. Clinical and pathological factors for desease-free (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis and survival curves were compared using the log-rank test. Cox multiple regression analysis was performed to determine the parameters predicting HCC recurrence and patient survival. The optimal cut-off value for elevated level of preoperative FBG was determined by using a receiver operating characteristic (ROC) curve analysis.

Results: FBG levels were significantly higher in patients with tumor recurrence (3.88±1.34 g/L) compared with those in patients without recurrence (2.5±0.87g/L) (P<0.001). A cut-off value for elevated FBG level of 2.71g/L was defined using ROC curve analysis. The sensitivity and specificity of elevated FBG to predict tumor recurrence after LT were 88.1% and 63.0%, respectively. There were significant differences in DFS and OS between elevated FBG group and normal FBG group (5-year DFS and OS of 33.4% and 35.3% vs. 84.6% and 81.3%, respectively, P<0.001). Thirty-three patients in elevated FBG group (57 cases) developed tumor recurrence during follow-up, while 5 patients in normal FBG group (39 cases) developed tumor recurrence. Univariate analysis of factors revealed that age<50 years old, tumor size>5cm, tumor number>3, vascular invasion, serum AFP level≥400μg/L, beyond Milan criteria, and FBG ≥2.71g/L were preoperative predictors of DFS and OS. Cox regression analysis showed that vascular invasion, tumor number>3, AFP≥400μg/L, and FBG≥2.71g/L were independent prognostic factors of poorer DFS, and vascular invasion, AFP≥400μg/L, and FBG≥2.71g/L were independent prognostic factors of poorer OS.

Conclusion: Pretransplant elevated FBG is associated with tumor recurrence and poor prognosis in patients after LT for HCC. Pretransplant FBG may aid in the selection of patients that would most benefit from transplantation for HCC.

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