Prognostic Value of Preoperative Fibrinogen in Metastatic Clear Cell Renal Cell Carcinoma Patients Undergoing Cytoreductive Nephrectomy.

OBJECTIVE

To investigate the prognostic association of preoperative plasma fibrinogen (FIB) levels with overall survival (OS) in patients with metastatic clear cell renal cell carcinoma (mccRCC) undergoing cytoreductive nephrectomy (CN).

METHODS

This retrospective study included 209 mccRCC patients who underwent CN from 2010 to 2022. Restricted cubic splines and Cox models assessed the association between FIB and OS. A data-derived cutoff was determined using time-dependent receiver operating characteristic analysis. Robustness was evaluated using propensity score matching (PSM) and sensitivity analyses. The additional prognostic information provided by FIB was assessed using discrimination, calibration, and decision curve analyses (DCA).

RESULTS

During a median follow-up of 61.4 months, 131 patients (62.7%) died, and median OS was 35.4 months (95% CI, 29.6-44.1). FIB was significantly associated with OS (overall P = .0012), with no significant evidence of nonlinearity. A cutoff of 4.44 g/L was identified. Patients with FIB ≥ 4.44 g/L had shorter median OS than those with FIB < 4.44 g/L (22.6 vs. 48.4 months; HR, 2.16; 95% CI, 1.53-3.06; P < .001). This association remained significant after PSM (HR, 1.78; 95% CI, 1.12-2.83; P = .013). In multivariable analysis, each 1 g/L increase in FIB was associated with higher mortality(HR, 1.19; 95% CI, 1.03-1.36; P = .015). Adding FIB to established clinical factors modestly improved model discrimination (C-index, 0.637 vs. 0.652) and model fit (P = .018), with a higher net benefit on DCA.

CONCLUSION

Elevated FIB was independently associated with shorter OS in patients with mccRCC undergoing CN. FIB provided modest additional prognostic information beyond established clinical factors, warranting external validation.