The advanced lung cancer inflammation index is the optimal inflammatory biomarker of overall survival in patients with lung cancer

Abstract

Backgrounds Malnutrition and systemic inflammatory responses are associated with poor overall survival (OS) in lung cancer patients, but it remains unclear which biomarkers are better for predicting their prognosis. This study tried to determine the best one among the existing common nutrition/inflammation-based indicators of OS for patients with lung cancer. Materials and methods There were 16 nutrition or systemic inflammation-based indicators included in this study. The cut-off points for the indicators were calculated using maximally selected rank statistics. The OS was evaluated using the Kaplan-Meier estimator, and univariate and multivariate Cox proportional hazard models were used to determine the relationship between the indicators and OS. A time-dependent receiver operating characteristic curves (time-ROC) and C-index were calculated to assess the predictive ability of the different indicators. Results There were 1772 patients with lung cancer included in this study. In univariate analysis, all 16 indicators were significantly associated with OS of the patients (all P < 0.001). Except for platelet-to-lymphocyte ratio, all other indicators were independent predictors of OS in multivariate analysis (all P < 0.05). Low advanced lung cancer inflammation index (ALI) was associated with higher mortality risk of lung cancer [hazard ratio, 1.30; 95% confidence interval (CI), 1.13-1.49]. The results of the time-AUC and C-index analyses indicated that the ALI (C-index: 0.611) had the best predictive ability on the OS in patients with lung cancer. In different sub-groups, the ALI was the best indicator for predicting the OS of lung cancer patients regardless of sex (C-index, 0.609 for men and 0.613 for women) or smoking status (C-index, 0.629 for non-smoker and 0.601 for smoker) and in patients aged <65 years (C-index, 0.613). However, the modified Glasgow prognostic score was superior to the other indicators in non-small cell lung cancer patients (C-index, 0.639) or patients aged ≥65 years (C-index, 0.610), and the glucose-to-lymphocyte ratio performed better prognostic ability in patients with small cell lung cancer (C-index, 0.601). Conclusions The prognostic ability of the ALI is superior to the other inflammation/nutrition-based indicators for all patients with lung cancer.

Triceps skinfold–albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study

“…The fact that the TA integrates this information might explain why it was superior to other indices that mainly consist of serum parameters. A recent study also found that integration of the BMI and albumin has greater performance in predicting overall survival than 15 other nutrition‐ or systemic inflammation‐based indicators in patients with lung cancer 24 . This supports our approach that integrated both an anthropometric measurement and a serum parameter to develop the TA.…”

“…It would thus be expected that the exclusion of the other indices would minimize the potential collinearity of the model. This approach was also supported by a recent study that compared the prognostic value of 16 indicators in patients with lung cancer 24 …”

“…Because prognostic indices, such as the geriatric nutrition risk index, can predict the prognosis of cancer cachexia, 10 we also calculated the baseline NRI, PNI, CONUT, systemic immune‐inflammation index (SII) and modified Glasgow prognostic score (mGPS) to compare their prognostic value with the TA according to the following approaches: NRI = (1.519 × serum albumin, g/L) + (41.7 × present weight/usual weight); PNI = 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm 3 ); SII = peripheral platelet × neutrophil/lymphocyte counts 24 ; and CONUT includes the serum albumin level, total lymphocyte counts and serum total cholesterol level. The detailed scoring method used by the CONUT has been described previously 24 ; mGPS includes the serum C‐reactive protein level and albumin level. The detailed scoring method used by the mGPS has been described previously 24 .…”

“…The detailed scoring method used by the CONUT has been described previously 24 ; mGPS includes the serum C‐reactive protein level and albumin level. The detailed scoring method used by the mGPS has been described previously 24 . Harrell's C index, 25 integrated discrimination improvement (IDI), 26 continuous net reclassification improvement (cNRI) 27 and time‐dependent receiver operating characteristic (ROC) curve estimation were calculated to evaluate and compare the discrimination performance of the prognostic indices.…”

The geriatric nutritional risk index is an effective tool to detect GLIM-defined malnutrition in rectal cancer patients

“…The prognostic nutritional index (PNI), based on total lymphocyte counts and serum albumin levels, has been shown to be a prognostic indicator in many types of malignancies (6). The advanced lung cancer inflammation index (ALI), which is composed of serum albumin levels, neutrophil-lymphocyte ratio (NLR) and body mass index (BMI), is related with the poor outcomes in patients with different types of cancer (7)(8)(9). Based on the routine examination of biochemical and anthropometric measurements, all quantitative and objective nutritional tools facilitate the simplification of nutritional assessment and dynamic surveillance.…”