Impact Of Prognostic Value Of Combined Detection Of Pre-Operative Album-to-Fibrinogen Ratio And Neutrophil-to-Lymphocyte Ratio In Esophageal Squamous Cell Carcinoma Patients

Objective: Hyperfibrinogenemia,malnutrition and systemic inflammatory response are related to malignant tumor,which play an important role in the prognosis of esophageal squamous cell carcinoma(ESCC).In this study,we retrospectively analyzed the value of AFNLR score composed of preoperative albumin-to-fibrinogen ratio(AFR)and neutrophil-to-lymphocyte ratio(NLR)in evaluating the prognosis of patients with esophageal squamous cell carcinoma after radical operation.According to the main factors related to the prognosis of patients with esophageal squamous cell carcinoma,we established a personalized prognosis prediction model.Materials and methods: This study included 215 patients with esophageal squamous cell carcinoma who underwent radical surgery between January 2013 and December 2015.According to the plasma level of albumin,fibrinogen,neutrophils,lymphocytes,monocytes and platelet counts before surgery,AFR(albumin-to-fibrinogen ratio),NLR(neutrophil-to-lymphocyte ratio),PLR(platelet-to-lymphocyte ratio),LMR(lymphocyte-to-monocyte ratio)and PNI(prognostic nutrition index)were calculated.The best cut-off of NLR and AFR was identified by ROC curve analysis.According to the cut-off value of low AFR(<12.06)and high NLR(≥1.78),215 esophageal cancer patients were classified as AFNLR score2(these two hematological abnormalities),1(one of which is abnormal)or 0(neither is abnormal).Kaplan-Meier method and multivariable Cox regression model were used to evaluate the independent prognostic significance of variables.Predictive nomogram was established to evaluate their predictive effect on the prognosis of patients after radical resection of esophageal squamous cell carcinoma,which was verified by the C-index and Calibration curve.Results: The optimal cut-off values of AFR,NLR,PLR,LMR,and PNI are 12.06,1.78,120.6,6.35,49.93,respectively.The area under the ROC curve of AFR and NLR is higher than that of PLR,LMR,and PNI.The AFNLR score composed of low AFR(<12.06)and high NLR(≥1.78)combined testing for the diagnosis of patients’ prognosis is Greater than single index detection and diagnosis(P<0.05).Univariate analysis showed that TMN stage(P<0.001),adjuvant treatment(P=0.020),AFNLR score(P<0.001),AFR(P<0.001),NLR(P<0.001),PLR(P=0.001),LMR(P=0.007),PNI(P=0.001)were significantly correlated with the prognosis of patients.Multiple factor analysis showed that AFNLR score(P<0.001),TMN stage(P<0.001),postoperative adjuvant therapy(P<0.001)were significantly related to the prognosis.In addition,based on the results of multivariate analysis,a nomogram of the prognosis of ESCC patients was established.Adding the AFNLR score to the prediction model increased the net reclassification improvement(NRI)by 35.5%(95%CI: 0.129-0.488,P<0.001),and increased the integrated discrimination improvement(IDI)by 9.0%(95%CI:0.036-0.185,P<0.001).The value of established nomogram model was proved by the C-index value(0.811,95%CI: 0.765-0.856)and calibration curve.Conclusion: The preoperative AFNLR score is an independent risk factor for the prognosis of patients after radical resection of esophageal squamous cell carcinoma.The prediction effect of the Nomogram prognostic prediction model containing the AFNLR score is significantly improved,which helps to more accurately stratify patients and achieve individualized multidisciplinary Treatment;AFNLR score has certain value in the evaluation of the prognosis of patients after radical resection of esophageal squamous cell carcinoma.