Preoperative Albumin-To-Globulin Ratio, Not Neutrophil-To-Lymphocyte Ratio, Predicts Overall Survival After Total Laryngectomy

Objective: To evaluate the prognostic significance of preoperative inflammatory markers including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) in patients with laryngeal squamous cell carcinoma (LSCC) undergoing total laryngectomy (TL). Methods: Patients were stratified by preoperative inflammatory markers: NLR > 3, PLR > 109.54, and AGR < 1.29; values were obtained from blood tests within 6 months prior to surgery. The primary outcome was overall survival (OS). Secondary outcomes included postoperative complications, emergency department (ED) visits, and length of hospitalisation. Multivariable analyses adjusted for age, sex, comorbidity burden, socioeconomic status, and prior radiation exposure. Results: A total of 616 patients included (mean age 67 years; 85% male). Low AGR was significantly associated with longer hospital stays, higher ED visit rates at 3, 6, and 12 months (p < 0.001), and reduced 1, 2, and 5-year survival (p = 0.01, 0.02, 0.003). NLR > 3 predicted longer hospitalisation (p = 0.019) and more frequent ED visits (p < 0.01), and PLR > 109.54 was associated with increased ED visits and lower 5-year survival. In multivariable models, only AGR < 1.29 remained a strong independent predictor of ED visits and mortality. Stratified analysis showed that this association persisted in patients without prior radiation (HR: 3.32; p = 0.002), but not in those who underwent salvage TL. Conclusion: Low preoperative albumin-to-globulin ratio (AGR) is an independent predictor of reduced OS in patients undergoing TL for LSCC. Incorporating AGR into preoperative risk assessment may help identify high-risk patients and inform clinical decision-making.