AFR And ADS Scores As Efficacy Evaluation And Prognostic Biomarkers For Postoperative Adjuvant Radio-chemotherapy In Patients With Esophageal Squamous Cell Carcinoma

BackgroundEsophageal cancer is the 8^th most common digestive malignancy and the 6^thh leading cause of cancer-related death in the world.China is high incidence of it,and more than 90%patients are esophageal squamous cell carcinoma（ESCC）.Although with the continuous development of surgical techniques and drugs of chemotherapy,some patients with ESCC have been effectively treated,the others are still in the late stages of the disease when they are found losing indication for surgery.Therefore,more and more people hope to find a simple and effective biomarker to diagnosis and predict recurrence and survival of ESCC patients,so as to prolong the life of the patients and improve the quality.Recently,many studies have shown that inflammation can accelerate tumor progression.They have confirmed the circulating blood ratios such as Neutrophil-lymphocyte ratio（NLR）,Neutrophils/（WBC-neutrophils）ratio（dNLR）,Platelet-lymphocyte ratio（PLR）and Lymphocyte-monocyte ratio（LMR）were all considered as prognostic markers of cancer.In addition,studies have also shown that higher preoperative fibrinogen（Fib）levels may cause tumor progression and poor prognosis.However,there are few reports on Fib and albumin（Alb）as prognostic indicators.ObjectiveThis study was to investigate the prognostic values of the preoperative Fib,albumin（Alb）,Alb/Fib ratio（AFR）and hematological parameters（NLR,dNLR,PLR,LMR）in ESCC patients.Materials and methods:A total of 153 patients who were first diagnosed with esophageal squamous cell cancer at the Second Affiliated Hospital of Nanchang University from January 2010to December 2013 were collected including the baseline characteristics of the patients.We detected preoperative circulating Alb,Fib and counts of neutrophil,monocyte,lymphocyte and platelet,and obtained overall survival（OS）by three years’follow-up in the cases.Predicted nomogram were used to evaluate the prognostic roles of them in ESCC patient.Results1.The optimal cut-off values of Fib,Alb,AFR,NLR,dNLR,PLR and LMR were 3.2 mg/dL,38.2 g/L,9.3,2.1,4.3,145.9 and 2.3,respectively.2.Fib（≥3.2mg/d L）,AFR（<9.3）,Alb（<38.2g/L）,dNLR（≥4.3）,PLR（≥145.9）and LMR（<2.3）were significantly associated with decreased OS in univariate analysis,and AFR（adjusted HR（95%CI）=2.381（1.152-4.926））,Alb（adjusted HR（95%CI）=2.398（1.342-4.273））,Fib（adjusted HR（95%CI）=2.148（1.229-3.753））,dNLR（adjusted HR（95%CI）=2.938（1.626-5.308））and PLR（adjusted HR（95%CI）=1.964（1.129-3.415））remained significant in multivariate Cox regression.3.The result of time-dependent receiver operating characteristics curve showed that AFR,dNLR and Alb shared high survival predicted efficacy comparing to Fib and PLR.4.A novel prognostic ADS score depending on AFR,Alb and dNLR（adjusted HR（95%CI）=3.197（1.813-5.639）for 1 score,adjusted HR（95%CI）=12.711（2.756-58.614）for 2 score）)was independent prognostic factor for ESCC.ESCC patients with higher ADS score could benefit from the adjuvant radio-chemotherapy（P=0.002）,however,no significant survival difference was observed in ESCC patient harbored 0,1 and 2 ADS scores without treatment of radio-chemotherapy.5.We observed a significant difference in c-index values of estimated nomograms including or without ADS score（0.676 vs.0.618,p=0.05）.Conclusions:Preoperative ADS score including AFR,Alb and dNLR can be used as a predictive indicator of postoperative adjuvant radio-chemotherapy and three years’OS,and the nomogram including the score apparently improved the predicted survival efficacy for surgically resected ESCC patients.