Association between Dietary Antioxidants, Serum Albumin/Globulin Ratio and Quality of Life in Esophageal Squamous Cell Carcinoma Patients: A 7-year Follow-up Study

Juwei Zhang ¹ Jinsong Zhou ¹ Siting Chen ¹ Yue Huang ¹ Zheng Lin ¹ Yuan Deng ¹ Minglian Qiu ² Zhisheng Xiang ³ Zhijian Hu ^1,4*

• ¹ Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
• ² Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
• ³ Department of Epidemiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
• ⁴ Department of Key Laboratory of the Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

Objective: This study aimed to explore the association between dietary antioxidant index (DAI) combined with serum albumin-to-globulin ratio (AGR) and postoperative Health-related quality of life (HRQOL) in patients with esophageal squamous cell carcinoma (ESCC).: All patients were newly diagnosed with ESCC and underwent radical esophagectomy. Dietary data and routine blood tests were collected preoperatively to compute DAI and AGR. HRQOL was assessed over 7 years post-surgery via telephone follow-up and analyzed longitudinally using a time to deterioration (TTD) model. The deterioration times were compared using the log-rank test, and the association of the combined DAI and AGR index with postoperative quality of life in ESCC patients was examined through Cox regression models. Results: A total of 238 ESCC patients were included in the study. The results indicate that compared to the low DAI-AGR group, the high DAI-AGR group had a lower rate of deterioration events, and the time to deterioration in emotional functioning (p=0.014), dysphagia (p=0.042), and speech problems (p=0.023) were significantly delayed. Cox proportional hazard model revealed that preoperative high DAI-AGR was associated with improvement in emotional functioning (HR=0.575, 95% CI: 0.368-0.898) and speech problems (HR=0.525, 95% CI: 0.298-0.925) in ESCC patients postoperatively, which remained significant even after adjusting for covariates. The stratified analysis revealed that this improvement was associated with demographic and clinical characteristics. Conclusions: Our findings suggest that high preoperative DAI-AGR is linked to enhanced postoperative HRQOL in ESCC patients, offering crucial insights for patients, practitioners, and researchers.