br In the current study we retrospectively examined the
In the current study, we retrospectively examined the prog-nostic value of hemostatic parameters in advanced pancreatic cancer cohort. Our result revealed that PT (HR ¼ 1.43, 95%
Univariate and multivariate analyses for overall survival using the Cox proportional hazards model.
Variables Parameter Univariate analysis
Fig. 2. Distribution of different risk groups in stage III, IV and whole cohort. P value was calculated by Pearson Chi-Square test.
Among various hemostatic parameters, prothrombin time (PT) and fibrinogen (FBG) are widely tested in clinical laboratories to demonstrate abnormalities in the coagulation and fibrinolysis systems. PT is the time taken for plasma to clot when exposed to
Median survival of different risk groups according to TNM Stages.
tissue factor (TF) and used to evaluate the extrinsic pathway of coagulation. The potential mechanisms for prolonged PT and cancer may be as follows: first, prolongation of PT indicates a deficiency or depletion of coagulation factors; second, the downregulation of liver biosynthetic capacity and the activation of the coagulation system may contribute this situation. Previous studies also confirmed that prolonged PT is associated with poor prognosis in lung cancer , hepatocellular carcinoma , and colorectal cancer .
Fibrinogen is a multifunctional protein synthesized by hepato-cytes. Previous studies have demonstrated that fibrinogen plays a vital role in tumorigenesis, including stroma formation, angiogen-esis, and hematogenous HG-9-91-01 . Some possible explana-tions for the pro-tumoral effect of fibrinogen have been postulated. First, it is one of the most common components of the extracellular matrix, providing structure to the tumor stroma . Second, fibrinogen also produces proliferative signals by acting as a scaffold for binding growth factors such as VEGF  and FGF-2  to promote cellular adhesion, proliferation and migration during angiogenesis, and tumor cell growth. Third, fibrinogen helps platelets adhere to tumor cells and in turn promote more fibrin-ogen aggregation around tumor cells . Platelets and fibrinogen facilitate each other to protect tumor cells from natural killer
Stage Scoring system Number (percentage) Median survival time 95% CI
Fig. 3. Kaplan-Meier survival curves estimated on OS of whole cohort and stage III, IV according to the scoring system.
cytotoxicity. Several studies have reported that elevated plasma fibrinogen level is an unfavorable prognostic prediction in non-small-cell lung cancer , esophageal cancer , gastric cancer .
Recent studies have confirmed that the platelet contributes to cancer progression and metastasis [34,35]. In this study, we found that high MPV is an independent predictor for shorter OS in advanced pancreatic cancer. The mean platelet volume (MPV) is the volume of the average circulating platelets in femtoliters and is an indicator of activated platelets . To date, the impact of MPV on survival of has not been fully understood in malignant tumors. Emerging evidence indicates that there is an increase in platelet number and activity in patients with a wide spectrum of malign-acies . Active platelet releases secretory factors that promote growth factors, chemokines, proangiogenic regulatory proteins, proteolytic enzymes and microparticles within the microenviron-ment to promote tumor cell growth and invasion . Previous studies have revealed that high MPV predicts poor prognosis in colorectal cancer , non-small-cell lung cancer , breast cancer .