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Purpose: The inflammatory microenvironment and hemostatic system are involved in several stages of tumor progression. The aim of this study was to assess the prognostic effect of fibrinogen-to-lymphocyte ratio (FLR) in esophageal squamous cell carcinoma (ESCC) patients who underwent radical esophagectomy. Patients and methods: We retrospectively reviewed 673 consecutive patients with ESCC who underwent radical esophagectomy from January 2009 to December 2012 at a major cancer hospital in Guangzhou, southern China. The cutoff points were defined by the X-tile software. The prognostic value of FLR for overall survival (OS), disease-free survival (DFS), and first-year mortality after surgery were analyzed using Cox proportional hazard regression model and logistic regression model. Survival was estimated by the Kaplan-Meier estimator and compared using the log-rank test. Results: The optimal cutoff point of FLR was 3.03. Compared with the FLR-low (≤3.03) group, the FLR-high (&gt;3.03) group included older patients (χ 2 =7.267, P =0.007), showed higher postoperative overall morbidity (24.7% vs 14.8%, χ 2 =5.414, P =0.020) and tended to die within one year (23.5% vs 10.9%, χ 2 =10.871, P =0.001). The FLR-high group showed significant lower 5-year OS rates (41.2% vs 53.7%, log-rank=6.827, P =0.009) and 5-year DFS rates (35.3% vs 48.0%, log-rank=5.954, P =0.015) than the FLR-low group. Multivariate analyses suggested that high FLR was an independent negative predictor of OS (HR: 1.448, 95%CI: 1.073-1.952, P =0.015), DFS (HR: 1.445, 95%CI: 1.084-1.925, P =0.012) and first-year mortality (HR: 2.123, 95%CI: 1.157-3.898, P =0.015). Conclusion: The preoperative FLR level could be used as a simple, noninvasive, inexpensive, and potentially effective indicator to evaluate the prognosis of ESCC patients following radical esophagectomy.

cancer management and research

&lt;p&gt;A novel preoperative plasma indicator to predict prognoses for patients with esophageal squamous cell carcinoma after radical esophagectomy: fibrinogen-to-lymphocyte ratio&lt;/p&gt;