Low preoperative albumin-globulin score predicts favorable survival in esophageal squamous cell carcinoma

// Fei Zhang 1, 2, 3, * , Peng Sun 1, 2, 3, * , Zhi-qiang Wang 1, 2, 3 , De-shen Wang 1, 2, 3 , Yun Wang 1, 2, 3 , Dong-sheng Zhang 1, 2, 3 , Feng-hua Wang 1, 2, 3 , Jian-hua Fu 1, 2, 4, 5 , Rui-hua Xu 1, 2, 3 , Yu-hong Li 1, 2, 3 1 Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People’s Republic of China 2 State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, People’s Republic of China 3 Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China 4 Guangdong Esophageal Cancer Institute, Guangzhou, Guangdong, 510060, People’s Republic of China 5 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China * These authors contributed equally to this work Correspondence to: Yu-hong Li, e-mail: liyh19990@163.com Keywords: esophageal squamous cell carcinoma, albumin-globulin score, albumin/globulin ratio, survival Received: January 16, 2016 Accepted: March 31, 2016 Published: April 20, 2016 ABSTRACT This study retrospectively investigated the prognostic significance of the preoperative albumin-globulin score (AGS) and albumin/globulin ratio (AGR) in esophageal squamous cell carcinoma (ESCC). A cohort of 458 newly diagnosed ESCC patients who underwent radical esophagectomy in Sun Yat-sen University Cancer Center (Guangzhou, China) between January 2006 and December 2010 were selected into this study. The optimal cut-off value was identified to be 45.6 g/L, 26.9 g/L and 1.30 for albumin (ALB), globulin (GLB) and AGR in terms of survival, respectively. Patients with low ALB levels (< 45.6 g/L) and high GLB levels (≥ 26.9 g/L) were assigned an AGS of 2, those with only one of the two abnormalities were assigned an AGS of 1, and those with neither of the two abnormalities were assigned an AGS of 0. Univariate survival analysis showed that low AGS (0) was significantly associated with favorable disease free survival (DFS) [hazard ratio (HR), 0.635; 95% confidence interval (CI), 0.441–0.914; P = 0.015] and overall survival (OS) (HR, 0.578; 95% CI, 0.387–0.862; P = 0.007), and it remained an independent predictor for OS (HR, 0.630; 95% CI, 0.418–0.952; P = 0.028), but not for DFS (HR, 0.697; 95% CI, 0.479–1.061; P = 0.060) in multivariate models. High AGR (≥ 1.30) was also correlated with favorable DFS (HR, 0.626; 95% CI, 0.430–0.910; P = 0.014) and OS (HR, 0.622; 95% CI, 0.422–0.916; P = 0.016) in univariate analysis, but it failed to be an independent prognostic indicator for DFS (HR, 0.730; 95% CI, 0.494–1.078; P = 0.114) or OS (HR, 0.759; 95% CI, 0.507–1.137; P = 0.181) by multivariate analysis. Low preoperative AGS could serve as a valuable and convenient biochemical marker to predict favorable long-term survival in ESCC patients.