Decreased Average Albumin-to-Globulin Ratio During Radiotherapy Worsens the Prognosis of Esophageal Squamous Cell Carcinoma: Implications for Nutritional Management
Authors:   Department of Nosocomial Infection Management, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Cai Fen , Zhang Xiu Lian ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Wu Xiao Ling ,   Endoscope Room of the Clinic, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Zhuang Ting Ting ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Huang Lei ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Tu Yi Fei ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Lu Yuan Yuan ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Jiang Min Xia ,   Department of Nosocomial Infection Management, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China, Zhang Qing Ying ,   Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China, Lin Yan ,   Department of Medical Imaging, the Second Afliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China, Ma Chang Chun ,   Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China,   Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515031, Guangdong, China
Published: April 2022

Objective Malnutrition and cachexia are common in esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy. This study evaluated how malnutrition- and cachexia-related indicators, including the albumin-to-globulin ratio (AGR), and their changes during radiotherapy predict the treatment outcomes. Methods We reviewed a total of 172 ESCC patients receiving radiotherapy (as a primary cohort) and performed a Cox regression analysis on potential prognostic factors, including the AGR, as well as the TNM stage and concomitant chemotherapy. A subsequent receiver operating characteristics (ROC) curve and Kaplan Meier survival analysis was performed for ESCC patients stratifed by the average AGR cut-oﬀ point. Results In addition to the well-documented factors (i.e. TNM stage and concomitant chemotherapy), the average AGR was a significant prognostic factor for ESCC patients receiving radiotherapy. By plotting the ROC curve of the average AGR with regard to the ESCC prognosis, we obtained cut-oﬀ points for the overall patients (cut-oﬀ point: 1.5, AUC: 0.636), for patients with stage Ⅱ/Ⅲ disease (cut-oﬀ point: 1.5, AUC: 0.611), and for patients with stage Ⅳ disease (cut-oﬀ point: 1.84, AUC: 0.900). The ESCC patients with higher average AGR had a signifcantly more favorable OS compared with those with a lower average AGR. Notably, ESCC patients who had an increasing ΔAGR during radiotherapy had a considerably more favorable OS compared with those with a decreasing ΔAGR. All of these fndings were reproducible in the validation cohort. Conclusion A lower average AGR is indicative of a poorer prognosis for ESCC patients following radiotherapy. Improving the nutritional status and preventing or ameliorating cachexia might contribute to improving the prognosis of ESCC patients.