Advanced lung cancer inflammation index predicts the outcomes of patients with non-metastatic gastric cancer after radical surgical resection

Huaxian Chen; Fengxiang Zhang; Dandong Luo; Jianping Guo; Yijia Lin; Shi Chen; Shi Yin; Xijie Chen; Junsheng Peng; Lei Lian

doi:10.21037/jgo-22-657

Advanced lung cancer inflammation index predicts the outcomes of patients with non-metastatic gastric cancer after radical surgical resection

J Gastrointest Oncol. 2023 Feb 28;14(1):85-96. doi: 10.21037/jgo-22-657. Epub 2023 Feb 3.

Authors

Huaxian Chen^#^{1

2}, Fengxiang Zhang^#^{1

2}, Dandong Luo^#^{1

2

3}, Jianping Guo^{1

2}, Yijia Lin^{1

2}, Shi Chen^{1

2}, Shi Yin^{1

2}, Xijie Chen^{1

2}, Junsheng Peng^{1

2}, Lei Lian^{1

2}

Affiliations

¹ Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
² Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³ Department of Pathology, the First People's Hospital of Kashi Prefecture, Kashi, China.

^# Contributed equally.

Abstract

Background: The prognostic value of the advanced lung cancer inflammation index (ALI) has been demonstrated in various tumors. However, the prognostic significance of ALI in non-metastatic gastric cancer (GC) remains unclear. This study aimed to identify the prognostic values of ALI in patients with non-metastatic GC who underwent radical surgical resection.

Methods: Patients who underwent radical surgery for non-metastatic GC from January 2008 to September 2020 were enrolled in this study. The preoperative ALI was calculated as follows: body mass index × serum albumin/neutrophil to lymphocyte ratio. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression analyses were performed to assess the association between ALI and survival. The potential of ALI was supported by sensitivity testing based on the propensity score matching (PSM) analysis.

Results: Low preoperative ALI was significantly correlated with male gender (P=0.037), older age (P=0.004), T3/4 stage (P=0.001), lymph node metastasis (P=0.030), Tumor Node Metastasis (TNM) stage classification progression (P=0.004), and vessel invasion (P=0.001). Patients with low ALI showed worse OS (P<0.001) and CSS (P=0.001) compared to those with high ALI. Multivariable analysis showed that ALI was an independent prognostic factor for both OS [hazard ratio (HR) =1.55; 95% confidence interval (CI), 1.11-2.16]; P=0.010] and CSS (HR =1.46; 95% CI, 1.01-2.10; P=0.043) in non-metastatic GC patients who underwent radical surgical resection. Further PSM analysis confirmed the prognostic value of ALI in the PSM cohort.

Conclusions: The preoperative ALI is associated with survival outcomes in patients who have undergone radical surgical resection for non-metastatic GC. Low ALI appears to predict a worse prognosis.

Keywords: Non-metastatic gastric cancer; advanced lung cancer inflammation index (ALI); inflammation; nutrition; prognosis.