SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Relationship between Preoperative Plasma Fibrinogen and Prognosis in Patients with Non-metastatic Gastric Cancer: A Systematic Review and Meta-Analysis
Provisionally accepted
- Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Background: Preoperative plasma fibrinogen (Fib) is a potential prognostic marker for various cancers, including gastric cancer. This systematic review and meta-analysis aimed to investigate the relationship between preoperative fibrinogen levels and prognosis in patients with non-metastatic gastric cancer patients. Methods: This meta-analysis was conducted in accordance with the PRISMA guidelines. A comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane Library was performed up to May 26, 2025, without language or date restrictions. Eligible studies reported multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and recurrence-free survival (RFS) in relation to preoperative fibrinogen levels. Subgroup and sensitivity analyses were performed, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Results: A total of 8 retrospective studies involving 4,281 patients were included. Pooled analysis revealed that elevated fibrinogen levels were significantly associated with poorer OS (HR = 1.56, 95% CI: 1.20–1.93, P < 0.001; I² = 57.0%) and RFS (HR = 2.08, 95% CI: 1.33– 2.82, P < 0.001; I² = 0%). Subgroup analyses confirmed consistent associations across age, sex, tumor stage, geographic region, and fibrinogen cut-off values. No significant publication bias was detected. Conclusions: Elevated preoperative fibrinogen levels are significantly associated with worse overall and recurrence-free survival in patients with non-metastatic gastric cancer, indicating its potential utility as a prognostic biomarker. Given the limited data on RFS, further large-scale prospective studies are needed to validate these findings and support its integration into individualized risk stratification models.
Keywords: gastric cancer, Fibrinogen, prognosis, overall survival, Recurrence-FreeSurvival, Systematic review, Meta-analysis
Received: 07 May 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Lei, Lv and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chi Lu, luchi_2024@163.com
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