Combining the Albumin-to-fibrinogen ratio and pathologic factors predicts survival in surgically treated patients with esophageal squamous cell carcinoma

Abstract Objectives The primary objectives of this research were to examine the prognostic significance of the albumin-to-fibrinogen ratio (AFR) in patients who have undergone surgery for esophageal squamous cell carcinoma (ESCC) and to develop an easily implementable predictive model with clinical utility. Methods The present study retrospectively analyzed the clinical data of 414 patients who underwent R0 resection after being diagnosed with stage I–III ESCC. The prognostic value of AFR was evaluated using Kaplan-Meier survival curves and COX proportional risk regression modeling, and the effectiveness of AFR compared with other inflammatory markers was evaluated. Additionally, a nomogram prediction model was developed, and its accuracy was evaluated using the receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves. Results AFR was significantly correlated with tumor length, T-stage, N-stage, pathological stage, and vascular infiltration (p<0.05 for all). The multivariate analysis results demonstrated that AFR was an independent prognostic factor that affected patient outcomes, whereas other inflammatory and nutritional biomarkers did not. Furthermore, the overall C-index of the nomogram risk prediction model was 0.737 (95 %-CI: 0.700–0.776). The calibration curves showed that the 3- and 5-year overall survival (OS) probabilities predicted by the nomogram were consistent with actual observations. Moreover, the DCA and ROC curves showed that our model had better clinical utility. Conclusions Preoperative AFR, a clinical indicator based on inflammation and nutrition, plays a clear role in the predictions of patient prognosis. The prognostic prediction model incorporating pathological factors and AFR demonstrates simplicity, efficacy, and exceptional accuracy.