Albumin-to-globulin ratio as a prognostic indicator in elderly patients with esophageal squamous cell carcinoma undergoing radical radiotherapy

Background: Nutritional status is closely associated with cancer outcomes. However, no previous study has investigated the albumin-to-globulin ratio (AGR), a widely used assessment indicator of nutritional status, in the context of radical radiotherapy prognosis for elderly patients diagnosed with esophageal squamous cell carcinoma (ESCC). As such, the present study aimed to explore the prognostic significance of pre-radiotherapy AGR in elderly patients with ESCC undergoing radical radiotherapy. Methods: Data from 136 elderly patients with ESCC, who underwent radical radiotherapy between 2014 and 2020 at the Radiotherapy Department of the Second Affiliated Hospital, Xi'an Jiaotong University (Xi'an, China), were retrospectively analyzed. The optimal cutoff value and predictive efficiency of pre-radiotherapy AGR were determined. The association between the AGR and clinicopathological features of patients with ESCC was analyzed separately. As a predictive indicator, the prognostic significance of the AGR was assessed using Kaplan-Meier survival curves, as well as univariate and multivariate analyses using Cox regression modeling. Results: The optimal cutoff for pre-radiotherapy AGR was 1.535, accompanied by a specificity of 0.692, a sensitivity of 0.644, and an area under the receiver operating characteristic curve of 0.723. The AGR exhibited a significant association with TNM, T, and N stages ( p < 0.05) in elderly patients with ESCC. Kaplan-Meier survival curve analysis revealed that a lower AGR before radiotherapy was associated with poorer overall survival in elderly patients (24.39 vs 66.81 months; p < 0.05). The pre-radiotherapy AGR ( p = 0.023), N stage ( p = 0.004), and age ( p = 0.020) were independent risk factors for ESCC in elderly patients. Conclusions: The AGR was an independent prognostic marker for elderly patients with ESCC undergoing radical radiotherapy and demonstrated potential as an auxiliary reference indicator for prognostic stratification.