A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: Neutrophil lymphocyte ratio/prealbumin ratio

Abstract

NLR/Alb (neutrophil lymphocyte ratio/albumin ratio), is a prognostic index for esophageal cancer has been confirmed. Prealbumin (PA) is more sensitive to malnutrition than albumin. A new prognostic index, named neutrophil lymphocyte ratio/prealbumin ratio (NLR/PA), for predicting the survival time in patients with esophageal squamous cell carcinoma (ESCC) was proposed.A retrospective study of 315 cases with ESCC was enrolled. The optimal cut-off values were evaluated by ROC curve (the receiver operating characteristics curve). Pearson correlation analyses were used to calculate the correlations among NLR, Alb, NLR/Alb and NLR/PA. The overall survival (OS) was calculated by Kaplan-Meier method. Cox regression analyses were performed to evaluate the prognostic factors.The optimal cut-off value was 0.01 for NLR/PA according to ROC curve. According to multivariate analyses, TNM stage, NLR, NLR/Alb, NLR/PA were prognostic factors for OS. The AUC area (the area under the receiver operating characteristics curves) of the NLR/PA was higher than the areas of NLR and NLR/Alb for all the patients. The index of NLR/ PA had a higher AUC area than that of the index of NLR or NLR/Alb for patients in stage I-II. But in stage III-IVA, the index of NLR had a higher AUC area than that of the index of NLR/PA or NLR/Alb.The index of NLR/PA is superior to the index of NLR as a prognostic indicator for patients with early stage (stage I-II) ESCC.

Figure 1

Pearson correlation analysis. Negative correlations between NLR and Alb (r = −0.054, P = .341, A), NLR and PA (r = −0.167, P = .002, B). Positive correlations between PA and Alb (r = 0.689, P < .001, C), NLR and NLR/Alb (r = 0.956, P < .001, D), NLR and NLR/PA (r = 0.821, P < .001, E).

Figure 2

Kaplan-Meier survival curves for OS in 315 patients. (A) NLR; (B) NLR/Alb; (C) NLR/PA.

Figure 3

Comparisons of the AUC areas of these index for OS. AUC area = the area under the receiver operating characteristics curves.

Figure 4

Comparisons of the AUC areas of the 3 index for OS in different stages. (A) stage I-II; (B) stage III-IVA. AUC area = the area under the receiver operating characteristics curves.