Association of Preoperative Inflammatory Markers with Prognosis in Esophageal Squamous Cell Carcinoma: Development and Validation of a Survival Prognostic Model in a Two-Center Study

Abstract

Objective This study evaluates the prognostic value of preoperative inflammatory markers—Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), and Fibrinogen-to-Prealbumin Ratio (FPR)—in patients with resectable esophageal squamous cell carcinoma (ESCC). A survival prognostic model integrating these markers with TNM staging was developed and validated. Methods Clinical data from 224 ESCC patients who underwent surgical resection between January 2017 and December 2017 at the First Affiliated Hospital of the University of Science and Technology of China were retrospectively analyzed as a training set, and data from 87 patients at Tongling People's Hospital (January 2018 to September 2019) served as the validation set. ROC analysis determined optimal cut-off values for NLR, PLR, SII, and FPR. Survival was analyzed using the Kaplan-Meier method, and prognostic factors were identified through Cox regression. A nomogram was constructed using R software to predict overall survival (OS) and disease-free survival (DFS). Model performance was assessed via ROC, calibration curves, and decision curve analysis (DCA). Results The optimal cut-off values for NLR, PLR, SII, and FPR were 2.70, 140.34, 360.73, and 0.015, respectively. Higher NLR, PLR, and FPR levels were associated with significantly poorer 5-year OS and DFS (all p < 0.01), while higher SII levels were associated with improved outcomes (p = 0.008 for OS, p = 0.013 for DFS). Multivariate Cox analysis identified age, T stage, N stage, differentiation, and NLR as independent prognostic factors. The nomogram demonstrated strong predictive accuracy, with ROC AUCs of 0.966 (3-year OS), 0.907 (5-year OS), 0.960 (3-year DFS), and 0.919 (5-year DFS). Calibration curves confirmed model reliability, and DCA indicated high clinical utility. Conclusions Preoperative NLR, PLR, SII, and FPR are significant predictors of ESCC prognosis, with NLR serving as an independent marker. The nomogram based on inflammatory markers and clinicopathological factors accurately predicts patient outcomes, aiding preoperative decision-making and postoperative management.