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The immunosuppressive characteristics were clinically validated in patients with metastatic ESCC;thosewho had elevated FNG levelsshowed poor responseto nivolumab. This study successfully validated the prognostic impact of plasma FNG levels in an expanded cohort with ESCC. Accordingly, our findings showed that increased plasma FNG reflects an immunosuppressive tumor microenvironment that facilitates tumor progression and poor responses to nivolumab. This study successfully validated the prognostic impact of plasma FNG levels in an expand