Can plasma fibrinogen and D-dimer be used as prognostic biomarkers in patients with non-muscle-invasive bladder cancer?

ABSTRACT

Purpose: We aimed to evaluate the role of plasma fibrinogen and D-dimer as prognostic biomarkers in patients with non-muscle-invasive bladder cancer (NMIBC). Method(s) A prospective study that included 35 patients (30 males) with newly diagnosed NMIBC who underwent complete transurethral resection between September 2020 and December 2021. Patients with history of thromboembolic event or anticoagulant intake or active infection, patients with deranged hepatorenal functions, inflammatory bowel disease, refractory hypertension, or diagnosed with Covid-19 infection within 1 month before surgery or routine follow-up were excluded. Follow-up was done as per NCCN guidelines. Fibrinogen and D-dimer levels were measured within 7 days of surgery or follow-up and analyzed for recurrence-free survival (RFS) and progression-free survival (PFS). Cox regression analyses were adopted to assess the influence of these two parameters on RFS and PFS. Result(s) The mean age was 53.9 years with a median follow-up of 9 months. The cut-off values of fibrinogen and D-dimer were 402.5 mg/dl and 0.55 mug/ml, respectively. Kaplan-Meier analysis demonstrated that high fibrinogen and D-dimer levels were significantly related to poor RFS (p < 0.001) and PFS (p < 0.001). On multivariate analysis, only fibrinogen and D-dimer retained their significance for RFS (p = 0.026 and 0.014, respectively) and PFS (p = 0.027 and 0.042, respectively) but not tumor size. High levels of fibrinogen and D-dimer were also present in patients who had recurrence or progression at follow-up visits compared to the rest of the patients. Conclusion(s) High levels of fibrinogen and D-dimer may indicate worse prognosis in patients with NMIBC, suggesting that these two can be used as prognostic biomarkers.