Prognostic implications of plasma fibrinogen and serum C-reactive protein levels in non-small cell lung cancer resection and survival

Purpose: To investigate the prognostic implications of plasma fibrinogen and serum C-reactive protein (CRP) levels in tumour resection and survival following successful tumour resection in patients with non-small cell lung cancer (NSCLC). Methods: One hundred and fifty-three NSCLC patients who underwent surgical resection at a tertiary care hospital from January 2006 through December 2010 were enrolled. Pre-operative serum CRP and plasma fibrinogen levels were measured. The levels of these biomarkers correlated with tumour size and pathologic TNM stage. The possibility of complete resection and associated findings are reported. Results: Plasma fibrinogen (r = 0.381, p = 0.002) and serum CRP (r = 0.471, p < 0.001) levels were positively associated with tumour diameter. Increased levels of these biomarkers were significantly associated with sex, smoking status, histological type, tumour stage, and clinical stage. Partial tumour resection occurred in 28 % (27/95) of patients with an increased plasma fibrinogen level compared to 10 % (6/58) with a normal fibrinogen level (p = 0.008), and in 30 % (29/97) of patients with an increased serum CRP level compared to 11 % (6/56) with a normal CRP level (p = 0.006). Patients with elevated CRP and fibrinogen concentrations demonstrated higher susceptibility to disease advancement and survival compared to patients with normal fibrinogen and CRP levels. Conclusion: Pre-operative functional concentrations of serum CRP and plasma fibrinogen could serve as indicators of tumour resectability wherein a high tumour resection rate is possible in patients with favourable pre-operative levels of these biomarkers. Increased concentrations of serum CRP and plasma fibrinogen are associated with poor overall survival and progression-free survival.