Abstract
AimThe aim of our study was to investigate the prognostic value of preoperative advanced lung cancer inflammation index (ALI) and to establish prognostic nomograms for the prediction of survival outcomes in patients with oral cavity squamous cell carcinoma (OSCC).Materials and MethodsA total of 372 patients who received primary curative surgery for OSCC during 2008–2017 at a tertiary referral center were enrolled. We used the receiver operating characteristic curve to determine the optimal cutoff point of ALI. Through a Cox proportional hazards model and Kaplan–Meier analysis, we elucidated the ALI–overall survival (OS) and ALI–disease-free survival (DFS) associations. Prognostic nomograms based on ALI and the results of multivariate analysis were created to predict the OS and DFS. We used the concordance indices (C-indices) and calibration plots to assess the discriminatory and predictive ability.ResultsThe results revealed that the ALI cutoff was 33.6, and 105 and 267 patients had ALI values of <33.6 and ≥33.6, respectively. ALI < 33.6 significantly indicated lower OS (44.0% vs. 80.1%, p < 0.001) and DFS (33.6% vs. 62.8%; p < 0.001). In multivariate analysis, ALI < 33.6 was independently associated with poor OS and DFS (both p < 0.001). The C-indices of established nomograms were 0.773 and 0.674 for OS and DFS, respectively; moreover, the calibration plots revealed good consistency between nomogram-predicted and actual observed OS and DFS.ConclusionALI is a promising prognostic biomarker in patients undergoing primary surgery for OSCC; moreover, ALI-based nomograms may be a useful prognostic tool for individualized OS and DFS estimations.
Highlights
Squamous cell carcinoma (SCC) that inherently affects the head and neck is ranked sixth among the most common types of cancer worldwide, with oral cavity SCC (OSCC) representing a majority of the cases [1]
Systemic inflammation and malnutrition are responsible for cancer growth, tumorigenesis, and metastasis, and these can be assessed by routine laboratory examinations at the time of diagnosis [7, 8]; various nutrition/inflammationbased biomarkers, such as C-reactive protein–albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR), neutrophil-tolymphocyte ratio (NLR), and albumin–globulin ratio (AGR), are used for early estimation of head and neck cancer (HNC) prognosis [9,10,11,12]
Because advanced lung cancer inflammation index (ALI) was calculated using body mass index (BMI), the NLR, and albumin level, we conducted separate multivariate analyses to avoid the collinearity, and the results demonstrate that the association of advanced overall stage, presence of extranodal extension (ENE), poor cell differentiation, low albumin, high NLR, and low ALI with poor disease-free survival (DFS) and overall survival (OS) was strong
Summary
Squamous cell carcinoma (SCC) that inherently affects the head and neck is ranked sixth among the most common types of cancer worldwide, with oral cavity SCC (OSCC) representing a majority of the cases [1]. In 2013, Jafri et al first combined NLR, serum albumin level, and body mass index (BMI) into a unified advanced lung cancer inflammation index (ALI) and demonstrated its prognostic value in patients who had been diagnosed as having metastatic non–small-cell lung cancer (NSCLC) [13]. Jank et al first reported that a low ALI was in association with poor survival of patients with HNC [20]. They enrolled only 21 (22.6%) patients with OSCC and did not include some substantial prognostic factors of OSCC, such as depth of invasion (DOI) [22] and extranodal extension (ENE) [23], in their survival analysis
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