Preoperative plasma fibrinogen predicts cervical metastasis in patients with stage I/II carcinoma of the tongue.

The aim of this study was to evaluate the association of preoperative plasma fibrinogen levels with clinico-pathological parameters and disease-free survival in patients with oral tongue squamous cell carcinoma (OTSCC). We retrospectively studied 76 patients with OTSCC who underwent a partial glossectomy only, at a single centre, between 1996 and 2007. Among the 76 patients, 30 eventually developed cervical metastasis. Preoperative plasma fibrinogen levels were determined and correlated with clinico-pathological findings by t-test or analysis of variance methods. Univariate and multivariate analyses were used to determine the association of preoperative plasma fibrinogen levels and disease-free survival. Elevated levels of plasma fibrinogen were positively related with growth type (P<0.001), differentiation (P<0.001), thickness (P<0.001), and the infiltrative growth ratio (P=0.032). Univariate analysis showed that growth type (P<0.001), differentiation (P<0.001), thickness (P<0.001), and preoperative plasma fibrinogen levels (P<0.001) were significantly correlated with disease-free survival. Multivariate analysis showed that the plasma fibrinogen level remained an independent factor for disease-free survival after partial glossectomy for OTSCC (P=0.029). A high preoperative plasma fibrinogen level is an independent predictor of cervical metastasis after partial glossectomy for OTSCC. A conservative supraomohyoid neck dissection is appropriate in patients with stage I/II carcinoma of the tongue whose preoperative plasma fibrinogen is >300 mg/dl.