Decreased Average Albumin-to-Globulin Ratio During Radiotherapy Worsens the Prognosis of Esophageal Squamous Cell Carcinoma: Implications for Nutritional Management

Abstract: 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 stratified 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 significantly 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 findings 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.