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Advanced Lung Cancer Inflammation Index has Prognostic Impact in Stage I Non-Small Cell Lung Cancer: A Registry-Based
Camilla Højbjerg Gregersen1, Ninna Aggerholm-Pedersen2, Birgitte Sandfeld-Paulsen3
1Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark.
Background:
The Advanced Lung Cancer Inflammation Index (ALI) has shown potential as a prognostic marker in lung cancer, but its role in early-stage non-small cell lung cancer (NSCLC) remains underexplored. This study evaluated the prognostic value of ALI in stage I NSCLC patients.
Methods:
This registry-based study enrolled 934 stage I NSCLC patients diagnosed between 2015 and 2020 from the Danish Lung Cancer Registry (DLCR). Data from DLCR were merged with laboratory records. ALI was calculated as body mass index x albumin/neutrophil-to-lymphocyte ratio and dichotomized at the cohort median. Kaplan-Meier analysis (restricted mean survival time truncated at 6 years), Cox proportional hazards model, and C-statistics were used to assess the value of ALI on overall survival (OS) and disease-free survival (DFS).
Results:
In patients receiving stereotactic radiation therapy (RT) (n = 301), a significantly longer mean survival was observed in the high ALI group compared with the low ALI group (5.12 vs. 4.81 years; P = .040). Multivariate analysis confirmed ALI as an independent prognostic factor for OS (HR 0.70, 95% CI, 0.51-0.96). No significant association with DFS was observed. In the surgically treated patients (n = 633), ALI was not associated with OS or DFS. C-statistics demonstrated that adding ALI significantly improved prognostic models for OS but not DFS independent of treatment.
Conclusion:
ALI is an independent prognostic factor for OS in stage I NSCLC patients treated with stereotactic RT, but not in surgically treated patients. Incorporating ALI into prognostic models improved OS prediction, supporting its role as a simple biomarker in early-stage NSCLC.
