A novel preoperative plasma indicator to predict prognoses for patients with esophageal squamous cell carcinoma after radical esophagectomy: fibrinogen-to-lymphocyte ratio

Figures & data

Table 1 Comparison of patients’ characteristics between FLR-low and FLR-high groups

Variables	All patients (n=673)	FLR≤3.03 (n=588)	FLR＞3.03 (n=85)	P
Gender				0.061
Male	525 (78.0%)	452 (76.9%)	73 (85.9%)
Female	148 (22.0%)	136 (23.1%)	12 (14.1%)
Age				0.007
≤60	384 (57.1%)	347 (59.0%)	37 (43.5%)
＞60	289 (42.9%)	241 (41.0%)	48 (56.5%)
Surgical approach				0.725
Sweet	384 (57.1%)	334 (56.8%)	50 (58.8%)
Ivor Lewis/McKeown	289 (42.9%)	254 (43.2%)	35 (41.2%)
Location				0.530
Upper	70 (10.4%)	59 (10.0%)	11 (12.9%)
Middle	280 (41.6%)	248 (42.2%)	32 (37.6%)
Lower	323 (48.0%)	281 (47.8%)	42 (49.4%)
Tumor length				0.059
≤4 cm	472 (70.7%)	420 (71.9%)	52 (61.9%)
＞4 cm	196 (29.3%)	164 (28.1%)	32 (38.1%)
Differentiation				0.603
G1	125 (18.6%)	97 (18.0%)	28 (20.9%)
G2	344 (51.1%)	281 (52.1%)	63 (47.0%)
G3	204 (30.3%)	161 (29.9%)	43 (32.1%)
pT category				0.175
T1	81 (12.0%)	76 (12.9%)	5 (5.9%)
T2	138 (20.5%)	119 (20.2%)	19 (22.4%)
T3	454 (67.5%)	393 (66.8%)	61 (71.8%)
pN category				0.172
N0	358 (53.2%)	319 (54.3%)	39 (45.9%)
N1	182 (27.0%)	151 (25.7%)	31 (36.5%)
N2	100 (14.9%)	90 (15.3%)	10 (11.8%)
N3	33 (4.9%)	28 (4.8%)	5 (5.9%)
TNM stage				0.435
I	19 (2.8%)	18 (3.1%)	1 (1.2%)
II	220 (32.7%)	187 (31.8%)	33 (38.8%)
III	401 (59.6%)	355 (60.4%)	46 (54.1%)
IV	33 (4.9%)	28 (4.8%)	5 (5.9%)
Adjuvant therapy	169 (25.1%)	152 (25.9%)	17 (20.0%)	0.245
Overall morbidity	108 (16.0%)	87 (14.8%)	21 (24.7%)	0.020
First-year mortality	84 (12.5%)	64 (10.9%)	20 (23.5%)	0.001
Follow-up time (Median, IQR)	95.3 (19.5)	95.8 (19.7)	92.3 (21.3)	0.502

Note: Data in bold indicate significant differences.

Abbreviation: FLR, fibrinogen-to-lymphocyte ratio.

Table 2 Univariate Cox regression analysis for overall survival and disease-free survival

Variables	Overall survival		Disease-free survival
	HR (95%CI)	P	HR (95%CI)	P
Gender
Female* vs male	1.411 (1.077–1.849)	0.013	1.315 (1.021–1.693)	0.034
Age
≤60* vs >60	1.280 (1.040–1.576)	0.020	1.136 (0.931–1.386)	0.209
Surgical approach
Sweet	1 (reference)		1 (reference)
Ivor Lewis/McKeown	0.831 (0.673–1.027)	0.087	0.784 (0.640–0.961)	0.019
Location		0.160		0.166
Upper	1 (reference)		1 (reference)
Middle	0.867 (0.618–1.216)	0.408	0.949 (0.681–1.322)	0.755
Lower	0.745 (0.532–1.042)	0.086	0.793 (0.571–1.103)	0.169
Tumor length
≤4 cm* vs ＞4 cm	1.335 (1.070–1.666)	0.010	1.260 (1.017–1.560)	0.035
Differentiation		0.160		0.153
G1	1 (reference)		1 (reference)
G2	1.299 (0.966–1.748)	0.084	1.241 (0.936–1.643)	0.133
G3	1.342 (0.976–1.845)	0.070	1.344 (0.995–1.816)	0.054
pT category		＜0.001		＜0.001
T1	1 (reference)		1 (reference)
T2	1.792 (1.131–2.840)	0.013	1.711 (1.120–2.613)	0.013
T3	2.527 (1.677–3.809)	＜0.001	2.257 (1.549–3.288)	＜0.001
pN category		＜0.001		＜0.001
N0	1 (reference)		1 (reference)
N1	2.235 (1.738–2.873)	＜0.001	2.155 (1.700–2.732)	＜0.001
N2	3.521 (2.666–4.649)	＜0.001	3.478 (2.663–4.542)	＜0.001
N3	4.680 (3.141–6.973)	＜0.001	4.184 (2.821–6.205)	＜0.001
Overall morbidity
No* vs Yes	1.089 (0.824–1.440)	0.548	0.937 (0.712–1.234)	0.644
Adjuvant therapy	1.530 (1.221–1.916)	＜0.001	1.700 (1.371–2.107)	＜0.001
Fibrinogen (g/L)
≤4.0* vs >4.0	1.382 (1.106–1.726)	0.004	1.333 (1.078–1.650)	0.008
Lymphocyte (10^9/L)
≤1.40* vs >1.40	0.729 (0.566–0.939)	0.014	0.794 (0.621–1.014)	0.065
FLR
≤3.03* vs >3.03	1.476 (1.100–1.981)	0.009	1.420 (1.070–1.884)	0.015

Notes: *Refer to reference category. Data in bold indicate significant differences.

Abbreviation: FLR, fibrinogen-to-lymphocyte ratio.

Table 3 Multivariate Cox regression analysis for overall survival and disease-free survival

Variables	Overall Survival		Disease-free Survival
	HR (95%CI)	P	HR (95%CI)	P
Gender
Female vs male		0.243		0.464
Age
≤60* vs >60	1.375 (1.113–1.698)	0.003
Surgical approach
Sweet			1 (reference)
Ivor Lewis/McKeown			0.711 (0.579–0.874)	0.001
Tumor length
≤4 cm vs >4 cm		0.552		0.679
pT category		0.001		0.012
T1	1 (reference)		1 (reference)
T2	1.575 (0.991–2.502)	0.055	1.585 (1.036–2.425)	0.034
T3	2.088 (1.382–3.157)	＜0.001	1.733 (1.210–2.596)	0.003
pN category		＜0.001		＜0.001
N0	1 (reference)		1 (reference)
N1	2.140 (1.663–2.754)	＜0.001	2.205 (1.734–2.803)	＜0.001
N2	3.532 (2.667–4.677)	＜0.001	3.616 (2.751–4.752)	＜0.001
N3	4.833 (3.225–7.241)	＜0.001	4.089 (2.749–6.083)	＜0.001
Adjuvant therapy		0.849		0.667
Fibrinogen (g/L)
≤4.0 vs >4.0		0.221		0.333
Lymphocyte (10^9/L)
≤1.40 vs >1.40		0.519		0.739
FLR
≤3.03* vs >3.03	1.448 (1.073–1.952)	0.015	1.445 (1.084–1.925)	0.012

Notes: *Refer to reference category. Data in bold indicate significant differences.

Abbreviation: FLR, fibrinogen-to-lymphocyte ratio.

Figure 1 Kaplan–Meier curves for (A) overall survival and (B) disease-free survival in the FLR-high group and FLR-low group.

Abbreviations: OS, overall survival; FLR, fibrinogen-to-lymphocyte ratio; DFS, disease-free survival.

Table 4 Univariate and multivariate logistic regression analyses of prognostic factors for first-year mortality

Variables	Univariate		Multivariate
HR (95%CI)	P	HR (95%CI)	P
Gender
Female* vs male	1.624 (0.872–3.024)	0.126
Age
≤60* vs >60	1.112 (0.703–1.762)	0.650
Surgical approach
Sweet	1 (reference)
Ivor Lewis/McKeown	0.891 (0.559–1.418)	0.626
Location		0.358
Upper	1 (reference)
Middle	1.329 (0.593–2.981)	0.489
Lower	0.942 (0.417–2.129)	0.886
Tumor length
≤4 cm* vs ＞4 cm	2.104 (1.318–3.359)	0.002	1.772 (1.082–2.903)	0.023
Differentiation		0.671
G1	1 (reference)
G2	1.052 (0.572–1.935)	0.872
G3	0.823 (0.415–1.636)	0.579
T category		0.013		0.068
T1	1 (reference)
T2	4.460 (0.987–20.152)	0.052		0.533
T3	6.959 (1.671–28.985)	＜0.001		0.062
N category		＜0.001		＜0.001
N0	1 (reference)		1 (reference)
N1	3.423 (1.911–6.133)	＜0.001	3.401 (1.869–6.189)	＜0.001
N2	4.012 (2.075–7.755)	＜0.001	3.861 (1.962–7.597)	＜0.001
N3	8.024 (3.438–18.725)	＜0.001	8.282 (3.445–19.911)	＜0.001
Overall morbidity
No* vs yes	1.923 (1.117–3.313)	0.018	2.187 (1.214–3.940)	0.009
Adjuvant therapy	1.799 (1.107–2.922)	0.018		0.595
Fibrinogen (g/L)
≤4.0* vs >4.0	2.082 (1.302–3.328)	0.002		0.208
Lymphocyte (10^9/L)
≤1.40* vs >1.40	0.530 (0.315–0.890)	0.016		0.591
FLR
≤3.03* vs >3.03	2.519 (1.433–4.430)	0.001	2.123 (1.157–3.898)	0.015

Notes: *Refer to reference category. Data in bold indicate significant differences.

Abbreviations: CI, confidence interval; FLR, fibrinogen-to-lymphocyte ratio.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.