Preoperative albumin-to-fibrinogen ratio as a predictor of postoperative hospital stay in locally advanced esophageal squamous cell carcinoma after neoadjuvant therapy

Abstract

Abstract Esophageal squamous cell carcinoma (ESCC) is a major global health issue, with postoperative hospital length of stay (LOS) being a critical factor influencing patient outcomes and healthcare costs. This study evaluates the impact of preoperative albumin-to-fibrinogen ratio (AFR) and albumin-to-D-II aggregates ratio (ADR) on LOS in patients with locally advanced ESCC undergoing neoadjuvant therapy. A retrospective study of 135 patients with locally advanced ESCC who underwent esophagectomy after neoadjuvant therapy (July 2013–November 2020). Demographic, clinical, and preoperative blood data were analyzed. LOS was defined from surgery to discharge. AFR and ADR values were calculated, and ROC curves identified optimal cutoffs. Multivariate Cox proportional hazards models and Kaplan–Meier analysis were used to assess relationships between AFR and LOS. The optimal AFR cutoff was 10.34, demonstrating better predictive accuracy for LOS than ADR. High AFR was associated with significantly shorter LOS. Multivariate analysis revealed high AFR, and cholesterol were linked to shorter stays, while older age and high globulin levels were associated with longer stays. Kaplan–Meier analysis confirmed the relationship. Preoperative AFR is a reliable predictor of LOS in advanced ESCC patients after neoadjuvant therapy, offering potential for improved clinical management and resource allocation.