<p>Prognostic Usefulness Of Advanced Lung Cancer Inflammation Index In Locally-Advanced Pancreatic Carcinoma Patients Treated With Radical Chemoradiotherapy</p>

Abstract

Background/AimsPreviously advanced lung cancer inflammation index (ALI) has been demonstrated to have prognostic utility in the stratification of patients into distinctive survival groups, but the prognostic value of ALI has never been explored in the setting of locally advanced pancreatic carcinomas (LAPC) treated with concurrent chemoradiotherapy (CCRT). Hence, we aimed to investigate the prognostic value of pre-treatment ALI in LAPC patients who underwent radical CCRT.MethodsPresent retrospective cohort analysis incorporated 141 LAPC patients who received radical CCRT. Accessibility of baseline ALI cutoff(s) impacting survival outcomes was sought by receiver operating characteristic (ROC) curve analysis. Interaction between the ALI and overall- (OS) and progression-free survival (PFS) comprised our primary and secondary endpoints, respectively.ResultsAt a median follow-up of 14.4 months (range: 3.2–74.2), the median PFS and OS were 7.5 (%95 CI: 5.9–9.1) and 14.6 months (%95 CI: 11.6–17.6), respectively. ROC curve analyses set the ideal ALI cutoff value at 25.3 (AUC: 75.6%; sensitivity: 72.7%; specificity: 70.3%) that exhibited significant associations with both the OS and PFS results. Patient stratification into two groups per ALI [≤25.3 (N=75) versus>25.3 (N=66)] showed that the ALI>25.3 group had significantly superior median OS (25.8 versus 11.4 months; P<0.001) and PFS (15.9 versus 6.0 months; P<0.001) durations than its ALI≤25.3 counterpart. Other factors exhibiting significantly better OS and PFS rates were N0 stage (versus N1; P<0.05 for each endpoint) and CA 19-9 ≤90 U/mL (versus >90 U/mL; P<0.05 for each endpoint), respectively. These three factors were additionally asserted to be independent indicators of longer OS (P<0.05 for each) and PFS (P<0.05 for each) in multivariate analyses.ConclusionResults of this hypothesis-generating research proposed the pre-CCRT ALI as a novel robust associate of OS and PFS outcomes for LAPC patients undergoing CCRT.

External validation of the prognostic relevance of the advanced lung cancer inflammation index (ALI) in pancreatic cancer patients

“…As opposed to the results of our present study, Topkan et al 30 only recently demonstrated the ALI as a significant and independent predictor for OS as well as progression‐free survival (PFS) in PC patients with locally advanced stages treated with chemoradiotherapy. Besides the specific study cohort of chemoradiotherapy‐treated locally advanced patients, the study comprised a smaller sample size (n = 141) and only patients with a BMI > 20 kg/m 2 were included 30 . In our study, 46 (10.7%) patients had a BMI of <20 kg/m2, which might be one significant difference as patients with a BMI below 20 are considered to be underweight and cachectic, a feature frequently encountered in metastatic PC patients 32 .…”

Prognostic Utility of Prechemoradiotherapy Albumin-to-Alkaline Phosphatase Ratio in Unresectable Locally Advanced Pancreatic Carcinoma Patients

“…Unresectable LAPAC was defined as a primary tumor involving the celiac axis and/or superior mesenteric artery, namely, stage III (T 4 N 0-2 M 0 ) disease per AJCC staging system (8 th ed.). Our standard diagnostic and staging workup for PAC patients was as previously reported elsewhere [16,17,41]. Briefly, all patients were carefully examined with abdominal magnetic resonance imaging (MRI), MR cholangiopancreatography, and endoscopic ultrasonography (if undergoing open abdominal exploration) for abdominal disease staging and chest computed tomography (CT) and brain MRI for the exclusion of lung/mediastinal and brain metastases, respectively.…”

“…As reported in detail previously [16,17,41], all eligible patients underwent a radical CCRT protocol consisting of a total dose of 45 Gy RT (1.8 Gy/fraction/day) that encompassed the index LAPAC and involved nodes. Elective nodal irradiation was unpermitted per our institutional standards for newly diagnosed LAPACs.…”

“…Applauding their requisite functions in the initiation, progression, and dissemination steps of PACs, several blood-borne biomarkers have been diligently scrutinized to stratify these patients into significantly discrete prognostic groups [7][8][9][10][11][12][13][14][15][16][17]. In this regard, serum albumin (ALB) and alkaline phosphatase (ALP), which are readily attainable from regular biochemistry tests, represent two estimable biomarkers regarding their ample capacity to accurately reflect the actual biological and pathological alterations in the nutritional, inflammatory, and immune status of cancer patients [18][19][20][21][22][23].…”

Low Advanced Lung Cancer Inflammation Index Predicts Poor Prognosis in Locally Advanced Nasopharyngeal Carcinoma Patients Treated with Definitive Concurrent Chemoradiotherapy

“…Jafri et al exhibited strong prognostic worth for the advanced lung cancer inflammation index (ALI), as a novel prognostic system, for patients with metastatic non-small-cell lung cancer [ 12 ]. The prognostic merit of ALI was also addressed in succeeding esophageal cancer [ 13 ], small-cell lung cancer [ 14 ], diffuse large B-cell lymphomas [ 15 ], pancreatic cancer [ 16 ], and head and neck squamous cell cancer [ 17 ] investigations and was invariably reported to be an independent prognosticator in these tumor locales too. Interestingly, to date, the prognostic value of ALI has never been addressed in LA-NPC patients who were managed with concurrent chemoradiotherapy (C-CRT).…”