Predictive Value Of Preoperative Albumin-to-fibrinogen Ratio On Prognosis In Patients Opera Ted For Esophageal Squamous Cell Carcinoma

Objective:The goal of the current study was to evaluate the prognostic significance of the albumin/fibrinogen ratio(AFR)in patients undergoing surgery for esophageal squamous cell carcinoma(ESCC)and build a predictive model with clinical utility and applicability.Methods:Retrospective analysis was done on the medical records of 209 patients who underwent R0 resection for stage I-IV ESCC at the First Hospital of Jilin University’s Department of Thoracic Surgery between January 2018 and December 2021.The optimal cutoff values for the patients’ preoperative AFR and other inflammatory and trophic indicators were determined using the X-tile program.Continuous variables were transformed into categorical variables based on the optimal critical values,and additional correlation analysis was carried out using the chi-square test and Fisher’s exact probability method.The Kaplan-Meier method was used to plot the survival curves,and the Log-Rank test was used for the one-way analysis.For factors having P< 0.1 in the univariate analysis,a multifactorial analysis was conducted using a COX proportional risk regression model.Based on the independent risk factors identified in the multifactorial analysis,a prognostic nomogram model was constructed using the R package RMS to predict the probability of 1-year and 3-year overall survival(OS)in patients undergoing esophageal cancer surgery.Bootstrap method(BH=1000)was used for internal validation,consistency index(C-index)was calculated and calibration curves were plotted to assess model discrimination and accuracy.P < 0.05 was considered a statistically significant difference.A column line graph prediction model was created using the R package RMS to forecast the likelihood of 1-year and3-year OS in patients receiving esophageal cancer surgery based on the independent risk factors discovered in the multifactorial analysis.Internal validation was performed using the bootstrap method(BH=1000),and model discrimination and accuracy were evaluated by computing the consistency index(C-index)and plotting calibration curves.A statistically significant difference was defined as P < 0.05.Results:The overall sample contained 12 female patients(5.7%)and 197 male patients(94.3%),with 116 patients aged ≤60 years and 93 patients aged >60 years.There were133 patients(63.6%)who smoked and 142 patients(67.9%)who drank alcohol.The optimal cutoff values of preoperative Fibrinogen(FIB),Albumin(ALB),Albumin-to-globulin Ratio(AGR),Neutrophil-to-lymphocyte Ratio(NLR),and Platelet-to-lymphocyte Ratio(PLR),Lymphocyte-to-monocyte Ratio(LMR),Prognostic Nutritional Index(PNI),Systemic Immune-inflammatory Index(SII),and AFR were 3.8,38.4,1.4,2.2,124.3,5.0,46.3,306.1,and 9.0,respectively.Correlation analysis between preoperative AFR and clinicopathological variables showed that AFR was significantly correlated with NLR,PLR,SII,PNI,AGR,tumor size,degree of differentiation,T stage,N stage,pathological stage,nerve infiltration,and vascular infiltration(all P < 0.05).The difference in distribution between groups suggested that low preoperative AFR was significantly associated with tumor progression.However,AFR did not correlate with patient age,gender,smoking history,alcohol history,tumor location,and LMR(all P > 0.05).Survival data showed a median follow-up of 24 months(interquartile: 17-41 months)for patients,with 73 patients dying at the end of follow-up.The overall 1-year OS rate was 87.6%,the2-year OS rate was 71.9%,and the 3-year OS rate was 65.0%.The results of univariate analysis showed that age,smoking,alcohol consumption,tumor location,AGR and comorbidities did not affect the postoperative survival of patients(all P >0.05).In contrast,the postoperative survival of patients with ESCC was affected by gender,adjuvant therapy,recurrence status,albumin,fibrinogen,NLR,PLR,AFR,SII,LMR,PNI,tumor size,degree of differentiation,pathological stage,T stage,N stage,vascular infiltration,and nerve infiltration(all P < 0.05).Age,AFR,clinical stage,and degree of differentiation were identified as independent risk factors affecting patient outcome by the COX multifactorial analysis results.The 3-year OS rate was significantly lower in the low-AFR group than in the high-AFR group in patients with stage I-II tumors(33.5% vs.82.9%,P < 0.001)and significantly lower in patients with stage III-IV tumors(24.1% vs.51.0%,P < 0.001),according to a subgroup analysis of tumor pathological stage.The overall C-index of the prognostic nomogram model was 0.771,(95% CI: 0.718-0.823).The 1-year and 3-year OS probabilities predicted by the prognostic nomogram were compatible with actual observations,according to internally confirmed calibration curves.Conclusions:1.The preoperative AFR is an inflammatory and nutritional based indicator that has application and can independently predict patient prognosis.2.The use of AFR has superior sensitivity and specificity in determining postoperative survival in patients with ESCC when compared to other inflammatory and nutritional indicators.3.The prognostic prediction model based on clinical parameters and AFR is easy to use and effective with good accuracy.