Plasma fibrinogen levels in patients with benign and malignant ovarian tumors

• Plasma fibrinogen levels and CA 125 are independently associated with ovarian cancer.
• In patients < 50 years, plasma fibrinogen levels can help in the differential diagnosis of ovarian tumors.
• Advanced tumor stage in ovarian cancer is associated with higher plasma fibrinogen levels.

ObjectivePlasma fibrinogen is a key acute phase protein and known to be elevated in ovarian cancer. We aimed to investigate the association between plasma fibrinogen and malignant and benign ovarian tumors.MethodsIn a retrospective, single-center study, we evaluated preoperative plasma fibrinogen levels in 471 patients with benign and in 224 patients with malignant (borderline ovarian tumor [BOT]: n = 36, epithelial ovarian cancer [EOC]: n = 188) ovarian tumors. The association between preoperative plasma fibrinogen levels and clinico-pathological parameters was investigated. A multivariate logistic regression model was performed to identify an independent association.ResultsMean (standard deviation) preoperative plasma fibrinogen levels in patients with benign ovarian tumors, BOT, and invasive ovarian cancers were 346.7 (99.7), 372.8 (114), and 472.6 (148.4) mg/dL, respectively (p < 0.001). Within the EOC cohort, patients with advanced stage disease had higher plasma fibrinogen levels (485.5 [151.3] mg/dL) than patients with early stage disease (430.9 [130.3] mg/dL; p = 0.03). In a multivariate model plasma fibrinogen was identified to be independently associated with the presence of BOT and EOC. In the subgroup of patients < 50 years, plasma fibrinogen levels remained independently associated with malignant ovarian tumors in CA 125 positive and negative patients.ConclusionPlasma fibrinogen levels are independently associated with malignant ovarian tumors. Plasma fibrinogen levels showed an independent association with malignant ovarian tumors in the subgroup of patients < 50 years, in whom differential diagnosis of ovarian tumors is particularly challenging.