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Journal of International Oncology ›› 2026, Vol. 53 ›› Issue (10): 591-599.doi: 10.3760/cma.j.cn371439-20251223-00094

• Original Article • Previous Articles     Next Articles

Predictive value of F-PLR score and LMR for the prognosis of patients with esophageal cancer receiving neoadjuvant immunotherapy combined with chemotherapy

Cui Xiaohui, Miao Yanan, Cao Ranhua()   

  1. Department of Oncology， Affiliated Hospital of Inner Mongolia Medical University， Hohhot 010050， China
  • Received:2025-12-23 Online:2026-10-08 Published:2026-10-10
  • Contact: Cao Ranhua E-mail:15034792565@163.com

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Abstract:

Objective To explore the predictive value of the pre-treatment fibrinogen combined with platelet-to-lymphocyte ratio （F-PLR） score and the lymphocyte-to-monocyte ratio （LMR） for the prognosis of patients with esophageal cancer receiving radical surgery after neoadjuvant immunotherapy combined with chemotherapy. Methods A retrospective analysis was conducted on the clinical data of 113 patients diagnosed with esophageal cancer and underwent radical esophageal cancer surgery after neoadjuvant immunotherapy combined with chemotherapy at the Affiliated Hospital of Inner Mongolia Medical University from January 2020 to December 2023. Optimal cut-off values for fibrinogen， platelet-to-lymphocyte ratio （PLR）， and LMR in predicting overall survival （OS） were determined by receiver operator characteristic （ROC） curve analysis. Patients were stratified into groups based on the F-PLR score and LMR optimal cut-off. Between-group comparisons of clinicopathological characteristics were performed using the chi-square test. The survival curve was plotted using the Kaplan-Meier method， with differences assessed via the log-rank test. Univariate and multivariate prognostic analysis was conducted using Cox proportional hazards regression model. Results ROC curve analysis showed that the areas under the curve （AUCs） for fibrinogen， PLR， F-PLR score， and LMR were 0.635， 0.710， 0.757， and 0.757， respectively. The optimal cut-off values were 3.71 g/L for fibrinogen， 129.19 for PLR， and 4.36 for LMR. Patients with different F-PLR scores （0 point， n=60； 1 point， n=34； and 2 points， n=19） showed statistically significant differences in tumor length （χ2=8.56， P=0.014）， clinical stage （χ2=9.16， P=0.010）， and T stage （χ2=10.27， P=0.006）. There were statistically significant differences in the levels of LMR （≥4.36， n=40； <4.36， n=73） among patients with different smoking history （χ²=5.72， P=0.017） and clinical stage （χ²=4.51， P=0.034）. Kaplan-Meier analysis revealed that the median progression-free survival （PFS） for patients with F-PLR scores of 0， 1， and 2 points were not reached， 34 months， and 26 months， respectively， and the median OS were not reached， 35 months， and 29 months， respectively， with statistically significant differences （χ²=8.46， P=0.015； χ²=21.32， P<0.001）. The median PFS for the high-LMR group and low-LMR group were not reached and 34 months， respectively， and the median OS were not reached and 37 months， respectively， with statistically significant differences（χ²=4.56， P=0.033； χ²=18.44， P<0.001）. Univariate analysis showed that tumor location （HR=0.52， 95%CI：0.28-0.97， P=0.041）， clinical stage （HR=5.71， 95%CI：2.84-11.48， P<0.001）， T stage （HR=2.49， 95%CI：1.28-4.85， P=0.007）， N stage （HR=4.38， 95%CI：2.27-8.48， P<0.001）， PLR （HR=2.43， 95%CI：1.30-4.53， P=0.005）， and F-PLR score of 2 （HR=2.86， 95%CI：1.31-6.26， P=0.008） were the influencing factors of PFS in patients with esophageal cancer who underwent radical surgery following neoadjuvant immunotherapy combined with chemotherapy， while pathological type （HR=3.46， 95%CI：1.41-8.51， P=0.007）， clinical stage （HR=5.66， 95%CI：2.69-11.92， P<0.001）， T stage （HR=5.01， 95%CI：2.05-12.29， P<0.001）， N stage （HR=2.90， 95%CI：1.42-5.92， P=0.003）， fibrinogen （HR=2.69， 95%CI：1.34-5.42， P=0.005）， PLR （HR=4.27， 95%CI：2.01-9.05， P<0.001）， F-PLR score of 1 （HR=5.62， 95%CI：2.17-14.54， P<0.001）， F-PLR score of 2 （HR=6.46， 95%CI：2.36-17.65， P<0.001）， and LMR （HR=0.05， 95%CI：0.01-0.35， P=0.003） were the influencing factors of OS in these patients. Multivariate analysis showed that tumor location （HR=0.36， 95%CI：0.19-0.71， P=0.003） and N stage （HR=2.85， 95%CI：1.05-7.73， P=0.040） were independent influencing factors for PFS， whereas T stage （HR=4.34， 95%CI：1.51-12.42， P=0.006） and LMR （HR=0.06， 95%CI：0.01-0.48， P=0.008） were independent influencing factors for OS in patients with esophageal cancer who underwent radical surgery following neoadjuvant immunotherapy combined with chemotherapy. Conclusions Pre-treatment LMR has predictive value for OS， while the F-PLR score is not an independent influencing factor for either PFS or OS in patients with esophageal cancer receiving neoadjuvant immunotherapy combined with chemotherapy.

Key words: Esophageal neoplasms, Fibrinogen, Lymphocyte, Prognosis, Neoadjuvant therapy