The low advanced lung cancer inflammation index to predict poor prognosis of patients with metastatic non-small cell lung cancer.

Abstract

e21132 Background: Inflammation plays a crucial role in cancers, in which the advanced lung cancer inflammation index (ALI) is considered to be a potential factor reflecting systemic inflammation. This work aimed to explore the prognostic value of ALI in metastatic non-small cell lung cancer (NSCLC) and classify patients according to their potential risks and different prognosis. Methods: Non-small cell lung cancer patients with stage IV were included in this retrospective study who were diagnosed pathologically in Hubei Cancer Hospital from June 2012 to December 2013. Combined with relevant imaging data and exfoliative cytology, patients with non-small cell lung cancer were staged according to the eighth edition of TNM staging criteria for non-small cell lung cancer. We screened 318 patients who met the inclusion and exclusion criteria requirements. The clinicopathological and therapeutic data of the patients were collected through medical records, including age, sex, smoking and drinking, tumor site, tumor family history, histology, metastatic site, chemotherapy, radiotherapy, anti-VEGF therapy and EGFR-TKI therapy. The formula of ALI is body mass index (BMI, Kg / m2) × serum albumin (Alb, g / dl) / neutrophil-lymphocyte ratio (NLR). Categorical variables were analyzed by chi-square test or Fisher’s exact test. The OS rates was analyzed by Kaplan–Meier method and plotted with R language. Multivariate Cox proportional hazard model was used to analyze the relationship between ALI and OS. The nomogram based on the Multivariable Cox regression was establish, and the Harrell consistency index (C-index) was used to evaluate the predictive performance of the Cox regression model. Results: According to the optimal cut-off value determined by X-tile software, patients were divided into two groups: ALI < 32.6 and ALI ≥ 32.6 and the median OS in the high ALI group were better than those in the low ALI group (39.97 vs 19.23 months, p < 0.01). Local or distant metastases and some distant metastasis sites are related to prognosis. Multivariable Cox regression model confirmed that ALI (HR: 1.39; 95%CI: 1.03-1.89; P = 0.03) and chemotherapy (HR: 0.67; 95%CI: 0.49- 0.91; P = 0.01) were independent prognostic factors for OS in patients with metastatic non-small-cell lung cancer. Conclusions: The results of our study indicates that patients with low ALI tend to have lower OS in metastatic NSCLC, and ALI can serve as an effective prognostic factor for metastatic NSCLC patients.