Abstract
Objectives
Body composition and systemic inflammation/nutrition have been identified as important clinical factors in cancer patients. The modified advanced lung cancer inflammation index (mALI), which combines body composition and systemic inflammation/nutrition, is defined as appendicular skeletal muscle index × serum albumin/neutrophil–lymphocyte ratio. This retrospective study aimed to investigate associations between preoperative mALI and surgical outcomes in non-small cell lung cancer (NSCLC) patients.
Methods
We examined 665 patients with resectable stage I–III NSCLC who underwent pulmonary resection. Patients were divided into low-mALI (n = 168) and high-mALI (n = 497) based on the lower quartile. Kaplan–Meier curves and Cox regression analysis were used to assess the prognostic value of mALI. We then performed 1:1 propensity score matching (PSM) for high- and low-mALI to further investigate impacts on survival.
Results
Overall survival (OS) and recurrence-free survival (RFS) were both significantly poorer in the low-mALI group than in the high-mALI group (58.2% vs. 79.6%, P < 0.001; 48.8% vs. 66.7%, P < 0.001, respectively). Multivariate analysis revealed low-mALI as an independent predictor of OS (hazard ratio [HR], 2.116; 95% confidence interval (CI) 1.458–3.070; P < 0.001) and RFS (HR, 1.634; 95% CI 1.210–2.207; P = 0.001). After PSM, low-mALI remained as an independent predictor of OS (HR, 2.446; 95% CI 1.263–4.738; P = 0.008) and RFS (HR 1.835; 95% CI 1.074–3.137; P = 0.026).
Conclusion
Preoperative mALI appears to offer an independent predictor of poor surgical outcomes as a simple, routinely available, and inexpensive biomarker in patients with resectable NSCLC.
Similar content being viewed by others
Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.
Okami J, Shintani Y, Okumura M, Ito H, Ohtsuka T, Toyooka S, et al. Demographics, safety and quality, and prognostic information in both the seventh and eighth editions of the TNM classification in 18,973 surgical cases of the Japanese Joint Committee of Lung Cancer Registry Database in 2010. J Thorac Oncol. 2019;14:212–22.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.
Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144:646–74.
Alifano M, Mansuet-Lupo A, Lococo F, Roche N, Bobbio A, Canny E, et al. Systemic inflammation, nutritional status and tumor immune microenvironment determine outcome of resected non-small cell lung cancer. PLoS ONE. 2014;9: e106914.
Li N, Tian GW, Wang Y, Zhang H, Wang ZH, Li G. Prognostic role of the pretreatment C-reactive protein/albumin ratio in solid cancers: a meta-analysis. Sci Rep. 2017;7:41298.
Takenaka Y, Oya R, Kitamiura T, Ashida N, Shimizu K, Takemura K, et al. Platelet count and platelet-lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: meta-analysis. Head Neck. 2018;40:2714–23.
Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106: dju124.
Jafri SH, Shi R, Mills G. Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review. BMC Cancer. 2013;13:158.
Deng Y, Sun Y, Lin Y, Huang Y, Chi P. Clinical implication of the advanced lung cancer inflammation index in patients with right-sided colon cancer after complete mesocolic excision: a propensity score-matched analysis. World J Surg Oncol. 2022;20:246.
Zhang X, Wang D, Sun T, Li W, Dang C. Advanced lung cancer inflammation index (ALI) predicts prognosis of patients with gastric cancer after surgical resection. BMC Cancer. 2022;22:684.
Park YH, Yi HG, Lee MH, Kim CS, Lim JH. Prognostic value of the pretreatment advanced lung cancer inflammation index (ALI) in diffuse large B cell lymphoma patients treated with R-CHOP chemotherapy. Acta Haematol. 2017;137:76–85.
Tomita M, Ayabe T, Nakamura K. The advanced lung cancer inflammation index is an independent prognostic factor after surgical resection in patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg. 2018;26:288–92.
Okugawa Y, Kitajima T, Yamamoto A, Shimura T, Kawamura M, Fujiwara T, et al. Clinical relevance of myopenia and myosteatosis in colorectal cancer. J Clin Med. 2022;11:2617.
Sato S, Sato M, Shinohara H. Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2023;71:354–62.
Xie HL, Ruan GT, Wei L, Zhang Q, Ge YZ, Song MM, et al. The prognostic value of the combination of body composition and systemic inflammation in patients with cancer cachexia. J Cachexia Sarcopenia Muscle. 2023;14:879–90.
Kim EY, Kim N, Kim YS, Seo JY, Park I, Ahn HK, et al. Prognostic significance of modified advanced lung cancer inflammation index (ALI) in patients with small cell lung cancer_ comparison with original ALI. PLoS ONE. 2016;11: e0164056.
Wen X, Wang M, Jiang CM, Zhang YM. Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults. Asia Pac J Clin Nutr. 2011;20:551–6.
Hu X, Zhang L, Wang H, Hao Q, Dong B, Yang M. Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Sci Rep. 2017;7:3171.
Yang M, Hu X, Wang H, Zhang L, Hao Q, Dong B. Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study. J Cachexia Sarcopenia Muscle. 2017;8:251–8.
Mao W, Wang K, Wu Y, Ni J, Zhang H, Wang Y, et al. Prognostic significance of modified advanced lung cancer inflammation index in patients with renal cell carcinoma undergoing laparoscopic nephrectomy: a multi-institutional, propensity score matching cohort study. Front Nutr. 2021;8: 781647.
Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle. 2015;6:197–207.
Takahashi M, Sowa T, Tokumasu H, Gomyoda T, Okada H, Ota S, et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2021;162(1257–68): e3.
Deans DA, Wigmore SJ, Gilmour H, Tisdale MJ, Fearon KC, Ross JA. Expression of the proteolysis-inducing factor core peptide mRNA is upregulated in both tumour and adjacent normal tissue in gastro-oesophageal malignancy. Br J Cancer. 2006;94:731–6.
Islam-Ali B, Khan S, Price SA, Tisdale MJ. Modulation of adipocyte G-protein expression in cancer cachexia by a lipid-mobilizing factor (LMF). Br J Cancer. 2001;85:758–63.
Tisdale MJ. Molecular pathways leading to cancer cachexia. Physiology (Bethesda). 2005;20:340–8.
Nishida Y, Tokunaga M, Kameyama A, Miyamoto M, Yoshifuku S, Sasahara K, et al. A prospective clinical study evaluating short-term changes in body composition and quality of life after gastrectomy in elderly patients receiving postoperative exercise and nutritional therapies. BMC Surg. 2023;23:181.
Acknowledgements
We wish to thank FORTE Science Communications (https://www.forte-science.co.jp) for English language editing.
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sato, S., Sezaki, R. & Shinohara, H. Significance of preoperative evaluation of modified advanced lung cancer inflammation index for patients with resectable non-small cell lung cancer. Gen Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s11748-023-02003-9
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11748-023-02003-9