Albumin to Globulin Ratio Is an Independent Prognostic and Predictive Factor for Recurrence of Esophageal Cancer After Esophagectomy

<h3>Background/Aim:</h3> The albumin-to-globulin ratio (AGR) is a promising biomarker reflecting both the nutritional and inflammatory status in patients with gastrointestinal malignancies. However, the clinical significance of AGR in patients with recurrent esophageal cancer (EC) remains unclear. The aim of the present study was to evaluate the prognostic and predictive impact of AGR in patients with recurrent EC after esophagectomy. <h3>Patients and Methods:</h3> We retrospectively reviewed data for 91 patients with recurrent EC who received any treatment, including best supportive care, after recurrence at Yokohama City University between 2005 and 2022. The cut-off value of AGR was set at 1.4 based on previous studies and survival outcomes. Overall survival (OS) and treatment responses were compared between the AGR-low (&lt;1.4) and AGR-high (≥1.4) groups. <h3>Results:</h3> Fifty-three patients were categorized into the AGR-low group and 38 into the AGR-high group. The 1-, 3-, and 5-year OS rates were 28.6%, 12.8% and 12.8%, and 80.3%, 42.0% and 36.7%, respectively. In multivariate analysis, age ≥75 years [hazard ratio (HR)=1.808, 95% confidence interval (CI)=1.028-3.179, <i>p</i>=0.040] and low AGR (HR=3.573, 95% CI=2.043-6.249, <i>p</i>&lt;0.001) were identified as independent prognostic factors for poorer OS. The initiation rate of first-line chemotherapy was significantly lower in the AGR-low group than in the AGR-high group (62.2% <i>vs.</i> 89.5%, <i>p</i>=0.004). Furthermore, treatment response was significantly poorer for the AGR-low group, and low AGR was an independent predictive factor for poor treatment response (odds ratio=2.990, 95% CI=1.055-8.479, <i>p</i>=0.039). <h3>Conclusion:</h3> AGR was an independent prognostic and predictive biomarker in patients with recurrent EC. AGR may serve as a simple and clinically useful biomarker for predicting prognosis and guiding treatment strategies in patients with recurrent EC.