Table 1_Relationship between preoperative plasma fibrinogen and prognosis in patients with non-metastatic gastric cancer: a systematic review and meta-analysis.docx

BackgroundPreoperative 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.
MethodsThis 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).
ResultsA 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.
ConclusionsElevated 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.

**背景**：术前血浆纤维蛋白原（fibrinogen，Fib）是包括胃癌在内多种恶性肿瘤的潜在预后标志物。本系统评价与荟萃分析旨在探讨非转移性胃癌患者术前纤维蛋白原水平与预后的关联。
**方法**：本荟萃分析严格遵循PRISMA（系统评价与荟萃分析优先报告条目）指南开展。通过全面检索PubMed、Embase、Web of Science及Cochrane Library数据库，检索时限截至2025年5月26日，未设置语言与发表时间限制。纳入研究需报告与术前纤维蛋白原水平相关的总生存期（overall survival，OS）与无复发生存期（recurrence-free survival，RFS）的多变量校正风险比（hazard ratios，HR）及95%置信区间（confidence intervals，CI）。本研究实施了亚组分析与敏感性分析，并采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale，NOS）对纳入研究的质量进行评估。
**结果**：最终共纳入8项回顾性研究，涉及4281例患者。合并分析结果显示，纤维蛋白原水平升高与较差的总生存期（HR=1.56，95%CI：1.20~1.93，P<0.001；I²=57.0%）及无复发生存期（HR=2.08，95%CI：1.33~2.82，P<0.001；I²=0%）显著相关。亚组分析证实，在年龄、性别、肿瘤分期、地理区域及纤维蛋白原截断值的分层中，上述关联均保持稳定。未检测到显著的发表偏倚。
**结论**：非转移性胃癌患者术前纤维蛋白原水平升高与更差的总生存期及无复发生存期显著相关，提示其可作为潜在的预后生物标志物。鉴于当前无复发生存期相关研究数据有限，需开展进一步的大规模前瞻性研究以验证本研究结论，并支持其应用于个体化风险分层模型。