Clinical significance of fibrinogen and albumin score for postoperative recurrence in esophageal cancer patients.

14 Background: In order to predict the postoperative recurrence in esophageal cancer patients, we previously reported that esophageal cancer patients who had preoperative hyperfibrinogenemia (>350 mg/dl) showed high recurrence rate. Currently, combining the preoperative plasma fibrinogen level and serum albumin level, we established a new scoring system. In this study, we aim to clarify the validity of the fibrinogen and albumin score (FA score) in esophageal cancer patients. Methods: We retrospectively reviewed 215 patients who underwent curative transthoracic esophagectomy in our institution between January 2004 and August 2012. Preoperative plasma fibrinogen level and serum albumin level were confirmed in 204 patients. We investigated patient characteristics, clinicopathological factors, preoperative plasma fibrinogen level and plasma albumin level. Based on our previous reports, we defined a cutoff value of fibrinogen as 350 mg/dl. The cut off value of albumin was determined after the analysis of the albumin distribution in the present study. Prognostic score was constructed by assigning one point for hyperfibrinogenemia or hypoalbuminemia. Cumulative FA score was obtained by combining them. Results: Based on the result that preoperative serum albumin level was 4.1 ± 0.34 g/dl (mean ± SD), we defined a cutoff value of albumin as 4.0 g/dl. Approximately, 33% had hyperfibrinogenemia and 34% had hypoalbuminemia. The number of each FA score 0/1/2 was 98(48%)/75(37%)/31(15%) cases. The patients with advanced stage showed significantly high score. In survival univariate analysis, neoadjuvant treatment, depth of tumor invasion, lymph node metastasis, pretreatment stage, preoperative fibrinogen level and FA score were significantly correlated with postoperative disease free survival. In multivariate analysis, pretreatment stage and FA score were shown to predict postoperative DFS significantly. Conclusions: FA score was shown to predict postoperative recurrence in esophageal cancer patients. Both fibrinogen and albumin are popular indicators routinely measured in daily clinical practice, FA score may be highly validate and feasible.