Advanced Lung Cancer Inflammation Index Predicts Outcomes of Patients with Pathological Stage IA Lung Adenocarcinoma Following Surgical Resection

Combined influence of nutritional and inflammatory status and breast cancer: findings from the NHANES

BACKGROUND

Previous studies have hinted at the benefits of following an anti-inflammatory diet for potentially reducing breast cancer prevalence. However, the combined influence of diet and inflammation on breast cancer remains unclear.

METHODS

The advanced lung cancer inflammation index (ALI) was used to assess inflammation and nutritional status. Statistical methods, such as multivariable logistic regression, eXtreme Gradient Boosting (XGBoost) model, and subgroup analysis, were employed to analyze the impact of ALI on prevalence of BC. Additionally, a two-piece-wise logistic regression model with smoothing was used to determine the ALI threshold for BC prevalence. The study aimed to understand the mechanistic association between ALI levels and BC development.

RESULTS

The mean (SD) age of the study population was 50.0 (17.7) years, with 40.0% of individuals classified as obese. Comparing ALI tertiles to the lowest tertile, the odds ratios (95% CI) for breast cancer (BC) were 0.78 (0.62, 0.98) and 0.68 (0.52, 0.87) for T2-T3. The XGBoost machine learning model was employed to assess the importance of selected factors, revealing ALI as one of the top five variables influencing BC. Subgroup analysis identified a correlation between ALI, alcohol consumption, and menopausal status. Additionally, ALI levels were associated with decreased estradiol (E2) levels, increased total testosterone (TT)/E2 ratio, and TT/sex hormone-binding globulin (SHBG) ratio.

CONCLUSION

This study indicates a potential protective effect of ALI levels against breast cancer, possibly related to sex hormone disruption. The findings support the use of optimal therapeutic strategies for preventing breast cancer.

Pre-Operative Measures of Systemic Inflammation Predict Survival After Surgery for Primary Lung Cancer

BACKGROUND

Measures of systemic inflammation (MSIs) have been developed and shown to help predict prognosis in patients with lung cancer. However, studies investigating the impact of MSIs on outcomes solely in cohorts of patients undergoing curative-intent resection of NSCLC are lacking. In the era of individualized therapies, targeting inflammatory pathways could represent a novel addition to the armamentarium of lung cancer treatment.

METHODS

A multicentre retrospective review of patients who underwent primary lung cancer resection between 2012 and 2018 was undertaken. MSIs assessed were neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII), advanced lung cancer inflammation index (ALI), prognostic nutritional index (PNI) and haemoglobin albumin lymphocyte platelet (HALP) score. Cox regression analysis was performed to assess the impact of MSIs on overall survival.

RESULTS

A total of 5029 patients were included in the study. Overall 90-day mortality was 3.7% (n = 185). All MSIs were significantly associated with overall survival on univariable analysis. After multivariable Cox regression analyses, lower ALI (expressed as a continuous variable) (HR 1.000, 95% CI 1.000-1.000, P = .049) and ALI <366.43 (expressed as a dichotomous variable) (HR 1.362, 95% CI 1.137-1.631, P < .001) remained independently associated with reduced overall survival.

CONCLUSIONS

MSIs have emerged in this study as potentially important factors associated with survival following lung resection for NSCLC with curative intent. In particular, ALI has emerged as independently associated with long-term outcomes. The role of MSIs in the clinical management of patients with primary lung cancer requires further investigation.

Association of Nutritional Indices With Adverse Effects and Time-to-Treatment-Failure in Triple Therapy for Lung Cancer

BACKGROUND/AIM

Recent lung cancer treatments include an immune checkpoint inhibitor (ICI) pembrolizumab, platinum-based agents, plus an additional cytotoxic anticancer agent. Nutritional indices, such as the geriatric nutritional risk index (GNRI) and the prognostic nutritional index (PNI), are known to correlate with the prognosis of cancer chemotherapy. Several previous studies have investigated the relationship between PNI and treatment response in non-small cell lung cancer patients, reporting significantly increased OS and PFS in the high PNI group before treatment. However, the relationship between the three-drug combination and GNRI/PNI is unclear. The current study aimed to investigate the association of nutritional indices with duration of treatment success and occurrence of side effects in triple therapy.

PATIENTS AND METHODS

Seventy-two patients with non-small cell lung cancer, treated with combination of carboplatin, pemetrexed, and pembrolizumab from November 2019 to September 30, 2022, were classified into two groups (High and Low) for GNRI and PNI, and a retrospective study was performed.

RESULTS

In terms of time-to-treatment-failure (TTF), univariate and multivariate Cox proportional hazards regression analysis showed the Low-PNI group to have significantly shorter TTF than the High-PNI group (p=0.006); multivariate analysis results also showed PNI as a factor affecting TTF (HR=2.791, 95%CI=1.362-5.721, p=0.005). On the other hand, GNRI was not shown to be a factor affecting TTF.

CONCLUSION

PNI at the start of treatment was an independent prognostic factor affecting treatment success time (TTF) in non-small cell lung cancer patients receiving triple therapy. However, PNI was not shown to be a prognostic predictor of irAE development.

Exploring the implications of modified advanced lung cancer inflammation index on outcomes in patients with advanced non-small cell lung cancer

Aim

Sarcopenia and skeletal muscle density (SMD) have been shown to be both predictive and prognostic marker in oncology. Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). Computed tomography (CT) enables skeletal muscle to be quantified, whereas body mass index (BMI) cannot accurately reflect body composition. The purpose was to evaluate the prognostic value of modified ALI (mALI) using CT-determined third lumbar vertebra (L3) muscle index beyond original ALI and see the interaction between sarcopenia, SMD, neutrophil-lymphocyte ratio (NLR), ALI and mALI at baseline and post 4 cycles of chemotherapy and their effects on OS and progress free survival (PFS) in patients with advanced non-SCLC (NSCLC).

Methods

This retrospective study consisted of a total of 285 advanced NSCLC patients. The morphometric parameters such as SMD, skeletal muscle index (SMI) and fat-free mass (FFM) were measured by CT at the L3 vertebra. ALI was defined as BMI × serum albumin/NLR and mALI was defined as SMI × serum albumin/NLR.

Results

Sarcopenia was observed in over 70% of patients across all BMI categories. Patients having sarcopenia suffered from a higher incidence of chemotherapeutic drug toxicities but this was not found to be statistically significant. Concordance was seen between ALI and mALI in the pre-treatment setting and this was statistically significant. A significant proportion of patients with poor ALI (90.9%), poor pre-chemotherapy mALI (91.3%) and poor post-chemotherapy mALI (89%) had poor NLR and each of them was statistically significant.

Conclusions

In both univariate and multivariate analyses, this study demonstrated the statistical significance of sarcopenia, SMD, and mALI as predictive factors for OS. Additionally, sarcopenia and SMD were also found to be statistically significant factors in predicting PFS. These biomarkers could potentially help triage patients for active nutritional intervention for better outcomes.

Nomogram combining clinical and radiological characteristics for predicting the malignant probability of solitary pulmonary nodules measuring ≤ 2 cm

Background

At present, how to identify the benign or malignant nature of small (≤ 2 cm) solitary pulmonary nodules (SPN) are an urgent clinical challenge. This retrospective study aimed to develop a clinical prediction model combining clinical and radiological characteristics for assessing the probability of malignancy in SPNs measuring ≤ 2 cm.

Method

In this study, we included patients with SPNs measuring ≤ 2 cm who underwent pulmonary resection with definite pathology at Qilu Hospital of Shandong University from January 2020 to December 2021. Clinical features, preoperative biomarker results, and computed tomography characteristics were collected. The enrolled patients were randomized at a ratio of 7:3 into a training cohort of 775 and a validation cohort of 331. The training cohort was used to construct the predictive model, while the validation cohort was used to test the model independently. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. The prediction model and nomogram were established based on the independent risk factors. The receiver operating characteristic (ROC) curve was used to evaluate the identification ability of the model. The calibration power was evaluated using the Hosmer-Lemeshow test and calibration curve. The clinical utility of the nomogram was also assessed by decision curve analysis (DCA).

Result

A total of 1,106 patients were included in this study. Among them, the malignancy rate of SPNs was 85.08% (941/1,106). We finally identified the following six independent risk factors by logistic regression: age, carcinoembryonic antigen, nodule shape, calcification, maximum diameter, and consolidation-to-tumor ratio. The area under the ROC curve (AUC) for the training cohort was 0.764 (95% confidence interval [CI]: 0.714-0.814), and the AUC for the validation cohort was 0.729 (95% CI: 0.647-0.811), indicating that the prediction accuracy of nomogram was relatively good. The calibration curve of the predictive model also demonstrated a good calibration in both cohorts. DCA proved that the clinical prediction model was useful in clinical practice.

Conclusion

We developed and validated a predictive model and nomogram for estimating the probability of malignancy in SPNs measuring ≤ 2 cm. With the application of predictive models, thoracic surgeons can make more rational clinical decisions while avoiding overtreatment and wasting medical resources.

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

AIMS

Hematological markers that can be used for prognosis prediction for stage I lung adenocarcinoma (LUAD) are still lacking. Here, we examined the prognostic value of a combination of the red cell distribution width (RDW) and carcinoembryonic antigen (CEA), namely, the RDW-CEA score (RCS), in stage I LUAD.

MATERIALS AND METHODS

A retrospective study with 154 patients with stage I LUAD was conducted. Patients were divided into RCS 1 (decreased RDW and CEA), RCS 2 (decreased RDW and increased CEA, increased RDW and decreased CEA), and RCS 3 (increased RDW and CEA) subgroups based on the best optimal cutoff points of RDW and CEA for overall survival (OS). The differences in other clinicopathological parameters among RCS subgroups were calculated. Disease-free survival (DFS) and OS among these groups were determined by Kaplan-Meier analysis, and risk factors for outcome were calculated by a Cox proportional hazards model.

RESULTS

Seventy, 65, and 19 patients were assigned to the RCS 1, 2, and 3 subgroups, respectively. Patients ≥ 60 years (P < 0.001), male sex (P = 0.004), T₂ stage (P = 0.004), and IB stage (P = 0.006) were more significant in the RCS 2 or 3 subgroups. The RCS had a good area under the curve (AUC) for predicting DFS (AUC = 0.81, P < 0.001) and OS (AUC = 0.93, P < 0.001). The DFS (log-rank = 33.26, P < 0.001) and OS (log-rank = 42.05, P < 0.001) were significantly different among RCS subgroups, with RCS 3 patients displaying the worst survival compared to RCS 1 or 2 patients. RCS 3 was also an independent risk factor for both DFS and OS.

CONCLUSIONS

RCS is a useful prognostic indicator in stage I LUAD patients, and RCS 3 patients have poorer survival. However, randomized controlled trials are needed to validate our findings in the future.

Evaluation of the Prognostic Capacity of a Novel Survival Marker in Patients with Sinonasal Squamous Cell Carcinoma

Sinonasal squamous cell carcinoma (SNSCC) is a malignant tumor associated with poor survival, and easily obtainable prognostic markers are of high interest. Therefore, we aimed to assess the prognostic value of a novel survival index (SI) combining prognostic values of clinical (T and N classifications and invasion across Ohngren’s line), inflammatory (neutrophil-to-lymphocyte ratio), and nutritional (albumin and body-mass index) markers. All patients with primarily treated SNSCC between 2002 and 2020 (n = 51) were included. Each of the six SI components was stratified into a low- (0) and high-risk (1) categories. Subsequently, the cohort was stratified into low- (SI of 0–2) and high-risk SI groups (SI of 3–6). Overall survival (OS) and disease-free survival (DFS) were compared between patients with low- and high-risk SI. The log-rank test was used to test for statistical significance. Overall, the mortality rate was 41.2% (n = 21), and the recurrence rate was 43.1% (n = 22). We observed significantly better OS in patients with low-risk SI (n = 24/51, 47.1%, mean OS: 7.9 years, 95% confidence interval (CI): 6.3–9.6 years) than in high-risk SI (n = 27/51, 52.9%, mean OS: 3.4 years, 95% CI: 2.2–4.5 years; p = 0.013). Moreover, we also showed that patients with low-risk SI had a longer DFS than patients with high-risk SI (mean DFS: 6.4, 95% CI: 4.8–8.0 vs. mean DFS: 2.4 years, 95% CI 1.3–3.5, p = 0.012). The SI combines the prognostic capacity of well-established clinical, radiologic, inflammatory, and nutritional prognosticators and showed prognostic potential in our cohort of SNSCC patients.

Assessing the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Stage I Non-Small-Cell Lung Cancer with Complete Resection

Purpose. To explore the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in stage I non-small-cell lung cancer (NSCLC) undergoing surgery. Patients and Methods. Between 2014 and 2016, a total of 190 patients with postoperative pathology of stage I NSCLC who underwent radical surgery at Nanjing Chest Hospital were studied. Clinical data were analyzed and classified into low-risk, moderate-risk, and high-risk groups based on independent risk factors to assess the prognosis. Results. NLR was associated with histological type and gender, and patients with an elevated NLR have poor overall survival (OS). Lymphovascular invasion, red blood cell distribution width-standard deviation (RDW-SD), and carcinoembryonic antigen (CEA) were independent prognostic factors for progression-free survival (PFS) in postoperative patients with stage I NSCLC, while NLR, RDW-SD, and CEA were independent risk factors for OS. Both PFS and OS were shorter in the low-risk group than in the medium-risk and high-risk groups. Conclusions. NLR, RDW-SD, CEA, and lymphovascular invasion are independent risk factors for postoperative prognosis in patients with stage I NSCLC, and the combination has a predictive value.

Application of the advanced lung cancer inflammation index for patients with coronavirus disease 2019 pneumonia: Combined risk prediction model with lung cancer inflammation index, computed tomography and chest radiograph

The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years; male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2; P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%; P<0.001), and chest CT score (CCTS; median, 1 vs. 9; P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.

Prognostic value of pretreatment advanced lung cancer inflammation index in non-small cell lung cancer: a meta-analysis

Purpose To identify the prognostic value of pretreatment advanced lung cancer inflammation index (ALI) in non-small cell lung cancer (NSCLC) including surgical patients who were diagnosed with early stage. Methods The PubMed, EMBASE and Web of Science electronic databases were searched up to January 12, 2022 for relevant studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to assess the association between pretreatment ALI and overall survival (OS) or progression-free survival (PFS) of NSCLC patients. All statistical analyses were conducted by STATA 12.0 software. Results A total of 14 studies involving 3607 participates were included. The pooled results indicated that lower pretreatment ALI was significantly related with poorer OS (HR =2.20, 95% CI: 1.46-3.33, P<0.001) and PFS (HR =1.78, 95% CI: 1.49-2.13, P<0.001). Besides, subgroup analysis also demonstrated that lower pretreatment ALI was associated with worse OS in surgical (P<0.001) and non-metastatic (P<0.001) patients and worse PFS of surgical (P<0.001) NSCLC patients. Conclusion Pretreatment ALI was a novel and reliable prognostic indicator in NSCLC and lower pretreatment ALI predicted worse survival including patients diagnosed with early stage. However, more prospective high-quality studies are still needed to verify above findings.

The advanced lung cancer inflammation index is a novel independent prognosticator in colorectal cancer patients after curative resection

BACKGROUND

The advanced lung cancer inflammation index (ALI), which comprehensively evaluates the patient body composition and inflammation/nutritional status, is reportedly associated with the patient outcome in lung cancer. However, the clinical significance in colorectal cancer (CRC) patients after curative resection remains unclear.

METHODS

A total of 813 CRC patients after curative resection between April 2005 and June 2019 in a single institution were retrospectively enrolled. The association of the preoperative ALI (calculated as follows: body mass index × albumin value/neutrophil-to-lymphocyte ratio) with clinicopathological factors, postoperative complications, and survival was analyzed.

RESULTS

A low ALI was significantly associated with male gender, older age, a higher depth of tumor invasion, progressed TNM stage, and preoperative carcinoembryonic antigen (CEA) positivity. Both postoperative complications and severe complications occurred more frequently in the ALI-low group than in the ALI-high group (P < .001 and P < .001, respectively), especially postoperative complications in stage III patients (P < .001) and severe complications in stages II and III patients (P = .024 and P = .004, respectively). In addition, a low ALI was an independent predictor of a poor overall survival (hazard ratio: 2.30, 95% confidence interval: 1.52-3.50, P < .001) and relapse-free survival (hazard ratio: 1.73, 95% confidence interval: 1.22-2.44, P = .002), especially in older patients, and in patients without lymph node metastasis or severe postoperative complications.

CONCLUSION

This study suggests that preoperative ALI may serve as a novel independent predictive index for severe postoperative complications and recurrence in CRC patients after curative resection.

The advanced lung cancer inflammation index predicts outcomes of patients with non-small cell lung cancer following video-assisted thoracic surgery

OBJECTIVE

The advanced lung cancer inflammation index (ALI) predicts overall survival (OS) in patients with advanced lung cancer. However, few studies have tested ALI's prognostic effect in patients with non-small cell lung cancer (NSCLC) following video-assisted thoracic surgery (VATS), especially patients at stage III. This study investigated the relationship between ALI and outcomes of patients with NSCLC following VATS.

METHODS

We retrospectively examined 339 patients with NSCLC who underwent VATS at Hebei General Hospital, China. Preoperative clinical and laboratory parameters were collected and analyzed. Optimal cutoff values of potential prognostic factors, including ALI, were determined. Kaplan-Meier and Cox regression analyses were used to determine each factor's prognostic value.

RESULTS

The median OS was 31 months. The optimal cutoff value for ALI was 41.20. Patients with high ALI (≥41.20) displayed increased OS (33.87 vs. 30.24 months), higher survival rates, and milder clinical characteristics. Univariate and multivariate analyses showed a significant correlation between ALI and the prognosis of patients with NSCLC, including those at stage IIIA, who underwent VATS.

CONCLUSIONS

Low ALI correlated with poor outcomes in patients with NSCLC following VATS. Preoperative ALI might be a potential prognostic biomarker for patients with NSCLC following VATS, including patients at stage IIIA.

Comprehensive Analysis to Identify Enhancer-Regulated Inflammation-Associated Genes in Lung Adenocarcinoma

Objective

The purpose of this study was to identify prognostic inflammatory markers regulated by enhancers in lung adenocarcinoma (LUAD).

Methods

Inflammatory indices of 490 LUAD patients in TCGA database were calculated using genomic variation analysis (GSVA). Patients were divided into high- and low-inflammatory index groups. Fraction of 22 infiltrating immune cells was estimated using the Cell type Identification By Estimating Relative Subsets Of RNA Transcripts (CIBERSORT). Gene set enrichment analysis (GSEA) was used to analyze gene enrichment. Differentially expressed genes were screened based on TCGA database. The H3K27ac ChIP-seq of A549 cells in GEO database (GSE42374) was analyzed to identify super enhancers. Kaplan-Meier method and multivariate Cox proportional hazards models were used for survival analysis. CCK8 and RT-qPCR were used for cellular level verification.

Results

Inflammation was associated with better outcome in LUAD patients. Anti-cancer immune cell fractions were upregulated in high-inflammatory index group. Genes enriched in inflammation-related signaling pathways were positively correlated with high-inflammatory index group. A total of 146 upregulated genes regulated by enhancers were screened, of which five genes including GDF10, HPGDS, ABCA8, SLIT3 and ADAMTS8 had significant influence on prognosis. ChIP-seq analysis showed that TGFβ+TNFα treatment promoted the enhancer activation of the five genes. Cellular experiments revealed that there was no significant effect of TGFβ treatment on the five genes expression. TNFα treatment upregulated the five genes expression, while the BET-bromodomain inhibitor JQ1 restored the effect of TNFα. Overexpression of the five genes significantly inhibited the proliferation of A549 and H1299 cells.

Conclusion

GDF10, HPGDS, ABCA8, SLIT3 and ADAMTS8 were identified as enhancer-regulated prognostic inflammation-related biomarkers, and the expression of these genes inhibited proliferation of LUAD cells.

Prognostic effect of preoperative red cell distribution width on the survival of patients who have undergone surgery for non-small cell lung cancer

Red cell distribution width (RDW) is a prognostic factor for various malignancies, including colorectal, breast and lung cancer. The effect of preoperative RDW on the prognosis of patients who have undergone surgery for non-small cell lung cancer (NSCLC) was investigated in the present study. This retrospective, single-institution study included consecutive patients who had undergone complete NSCLC resection between January 2006 and December 2013 at the Department of Thoracic Surgery of Kansai Medical University Hospital (Hirakata, Japan). The overall and recurrence-free survival rates were compared using univariate and multivariate Cox proportional hazard models. A stepwise backward elimination method with a probability level of 0.15 was performed to select the most powerful outcome predictor sets. A total of 338 cases with NSCLC were analyzed. Of these, 25 had high RDWs (≥50 fl) and 313 had low RDWs (<50 fl). The 5-year overall survival rates in patients with high and low RDWs were 0.40 [95% confidence interval (CI): 0.21-0.58] and 0.80 (95% CI: 0.76-0.84), respectively, and the recurrence-free survival rates were 0.48 (95% CI: 0.25-0.68) and 0.70 (95% CI: 0.64-0.75), respectively. High RDW was identified as an independent prognostic factor for overall survival [hazard ratio (HR)=2.29; 95% CI: 1.3-4.01; P=0.004) but not for recurrence-free survival (HR=1.70; 95% CI: 0.93-3.12; P=0.085) by univariate and multivariate analysis. A high preoperative RDW was an independent predictor of poor prognosis in patients who had undergone radical resection of NSCLC. Therefore, patients with high RDW should be carefully monitored postoperatively, regardless of the disease stage.

Prognostic Impact of the Advanced Lung Cancer Inflammation Index (ALI) in Metastatic Non-Small Cell Lung Cancer Treated with First Line Chemotherapy

Background:

The advanced lung cancer inflammation index (ALI) has been reported to predict the overall survival in patients with advanced non-small cell lung cancer (NSCLC). However, no previous studies have examined the prognostic significance of ALI in metastatic NSCLC treated with first line chemotherapy. The objective of this study was to explore the relationship between ALI and the prognosis of metastatic NSCLC treated with first line chemotherapy.

Materials and Methods:

Data of 109 metastatic NSCLC patients who had completed first line treatment with chemotherapy was collected. A multivariate flexible parametric proportional-hazards model with restricted cubic splines (RCS) was used to explore and identify the independent prognostic factors, including clinical potential factors and ALI for the overall survival. Multivariate regression analysis was used to evaluate the potential prognostic factors associated with short survival less than 6 months. The analysis of the restricted mean survival time (RMST) method was used to estimate the event-free time from zero to 18 months.

Results:

The median OS was 10.9 months (95%CI 9.57-13.18) and median PFS was 7.5 months (95%CI 6.85-8.00).The multivariate survival analyses revealed two prognostic factors for worse survival: Poor ECOG PS (HR46.90; 95%CI 2.90-758.73; p=0.007) and progressive disease after completing the first line chemotherapy treatment (HR 2.85; 95%CI1.18-6.88; p=0.02),whereas a low ALI <11 referred to a non-significant prognostic factor (HR 1.42; 95%CI 0.67-3.01; p=0.364).The results of the multivariate regression analysis revealed that the low ALI and progressive disease status were significantly associated with the short survival outcome (OR 5.12; 95%CI 1.11-23.65; p=0.037; OR 12.57; 95%CI 3.00-52.73; p=0.001).

Conclusions:

A low ALI was associated with the short survival in metastatic NSCLC treated with chemotherapy. However, using ALI as a prognostic factor only was still too limited. Other considerable clinical prognostic factors should also be used simultaneously, which would have strong significant prognostic impacts.

Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy

BACKGROUND AND AIMS

Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer.

METHODS

We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed.

RESULTS

All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy.

CONCLUSIONS

A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.

Advanced Lung Cancer Inflammation Index is a Prognostic Factor of Patients with Small-Cell Lung Cancer Following Surgical Resection

Purpose

Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in advanced non small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC) and operable NSCLC. However, there were no studies of the correlation between ALI and operable SCLC. Therefore, this study is aimed to explore the relationship between ALI and the prognosis of operable SCLC.

Patients and Methods

A total of 48 patients with SCLC who underwent surgery at Hebei General Hospital and Zigong First People's Hospital were screened between 2016 and 2020. ALI was calculated as follows: body mass index (BMI, kg/m²)×serum albumin (ALB, g/dL)/neutrophil to lymphocyte ratio (NLR). Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of ALI. Patients were divided into two groups according to the cutoff point of ALI: low ALI group with ALI<48.2 and high ALI group with ALI≥48.2. Kaplan-Meier and Cox regression analysis were performed to assess the potential prognostic factors associated with OS.

Results

The optimal cutoff value of ALI was determined as 48.2. The low ALI group displayed more adverse clinical characteristics and poorer survival rates. Multivariate analysis revealed that ALI and Charlson comorbidity index (CCI) were significantly correlated with OS.

Conclusion

Low ALI was correlated with poor prognosis in patients with SCLC who underwent surgery. Preoperative ALI might serve as a potential prognostic marker for patients with operable SCLC.

Gamma-Glutamyl Transpeptidase to Platelet Ratio Is a Novel and Independent Prognostic Marker for Resectable Lung Cancer: A Propensity Score Matching Study

BACKGROUND

We report this propensity score matching (PSM) analysis to assess prognostic roles of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) in video-assisted thoracoscopic (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC).

METHODS

The PSM-based study conducted on our single-center prospectively collected database from January 2014 to August 2015 provided Kaplan-Meier survival analyses using the log-rank test to discriminate differences in overall survival (OS) and disease-free survival (DFS) between patients stratified by preoperative GPR.

RESULTS

Our study includes 379 patients diagnosed with operable primary stage I-II NSCLC. A GPR value at 0.16 was recognized as the optimal cutoff point for prognostic prediction. Both OS and DFS of patients with GPR ≥0.16 were significantly shortened when compared to those of patients with GPR <0.16. Patients with GPR ≥0.16 had significantly lower 5-year rates of OS and DFS than those of patients with GPR <0.16 (P <0.001). Significant associations between GPR and unfavorable survival still are validated in the PSM analysis. Multivariable Cox regression models on both the entire cohort and the PSM cohort consistently demonstrated that an elevated preoperative GPR could be an independent prognostic marker for both OS and DFS of resectable NSCLC.

CONCLUSIONS

GPR may be an effective and noninvasive prognostic biomarker in VATS lobectomy for surgically resectable NSCLC.

Using Systematized Nomenclature of Medicine clinical term codes to assign histological findings for prostate biopsies in the Gauteng province, South Africa: Lessons learnt

Background

Prostate cancer (PCa) is a leading male neoplasm in South Africa.

Objective

The aim of our study was to describe PCa using Systemized Nomenclature of Medicine (SNOMED) clinical terms codes, which have the potential to generate more timely data.

Methods

The retrospective study design was used to analyse prostate biopsy data from our laboratories using SNOMED morphology (M) and topography (T) codes where the term ’prostate’ was captured in the narrative report. Using M code descriptions, the diagnosis, sub-diagnosis, sub-result and International Classification of Diseases for Oncology (ICD-O-3) codes were assigned using a lookup table. Topography code descriptions identified biopsies of prostatic origin. Lookup tables were prepared using Microsoft Excel and combined with the data extracts using Access. Contingency tables reported M and T codes, diagnosis and sub-diagnosis frequencies.

Results

An M and T code was reported for 88% (n = 22 009) of biopsies. Of these, 20 551 (93.37%) were of prostatic origin. A benign diagnosis (ICD-O-3:8000/0) was reported for 10 441 biopsies (50.81%) and 45.26% had a malignant diagnosis (n = 9302). An adenocarcinoma (8140/3) sub-diagnosis was reported for 88.16% of malignant biopsies (n = 8201). An atypia diagnosis was reported for 760 biopsies (3.7%). Inflammation (39.03%) and hyperplasia (20.82%) were the predominant benign sub-diagnoses.

Conclusion

Our study demonstrated the feasibility of generating PCa data using SNOMED codes from national laboratory data. This highlights the need for extending the results of our study to a national level to deliver timeous monitoring of PCa trends.

Advanced Lung Cancer Inflammation Index Predicts Outcomes of Patients With Colorectal Cancer After Surgical Resection

BACKGROUND

The advanced lung cancer inflammation index is considered a useful prognostic biomarker of clinical outcomes in patients with malignancies. However, the prognostic value of the advanced lung cancer index in patients with colorectal cancer who underwent surgical resection remains unclear.

OBJECTIVE

In this study, we evaluated the prognostic value of the advanced lung cancer index in patients with colorectal cancer.

DESIGN

Prospectively obtained data of patients with colorectal cancer were retrospectively evaluated to clarify the clinical relevance of the advanced lung cancer index.

SETTINGS

We conducted this study at a single expert center.

PATIENTS

We enrolled 298 patients with colorectal cancer who underwent surgical resection in this retrospective study.

MAIN OUTCOME MEASURES

The primary outcome was the clinical relevance of the advanced lung cancer index in patients with rectal cancer.

RESULTS

Low status of advanced lung cancer index was significantly correlated with undifferentiated histology (p = 0.004), T stage progression (p < 0.001), R1/R2 resection for primary surgery (p = 0.004), and distant metastasis (p < 0.001). Multivariate analysis showed that low advanced lung cancer index status was an independent prognostic factor for both overall survival (HR = 3.21 (95% CI, 1.97-5.19); p < 0.001) and disease-free survival (HR = 2.13 (95% CI, 1.23-3.63); p = 0.008) in patients with colorectal cancer. Furthermore, the clinical burden of the advanced lung cancer index was consistent between sexes, and its prognostic value was verified in patients with clinically relevant stage III colorectal cancer.

LIMITATIONS

The present study had several limitations, including retrospective observation and a small sample size of Japanese patients from a single institution.

CONCLUSIONS

The advanced lung cancer index could be a useful prognostic indicator of clinical outcomes in patients who underwent surgical resection for colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B267. EL ÍNDICE AVANZADO DE INFLAMACIÓN DEL CÁNCER DE PULMÓN, PREDICE LOS RESULTADOS DE LOS PACIENTES CON CÁNCER COLORRECTAL DESPUÉS DE LA RESECCIÓN QUIRÚRGICA: El índice avanzado de inflamación del cáncer de pulmón, es considerado como un útil biomarcador pronóstico, en los resultados clínicos de pacientes con neoplasias malignas. Sin embargo, aún no está claro el valor pronóstico del índice avanzado de cáncer de pulmón, en pacientes con cáncer colorrectal sometidos a resección quirúrgica.Evaluar el valor pronóstico del índice avanzado del cáncer de pulmón, en pacientes con cáncer colorrectal.Los datos obtenidos prospectivamente de pacientes con cáncer colorrectal, fueron evaluados retrospectivamente, para aclarar la relevancia clínica del índice avanzado del cáncer de pulmónEstudio realizado en un solo centro experto.Estudio retrospectivo, incluyendo 298 pacientes con cáncer colorrectal, sometidos a resección quirúrgica.El resultado primario fue la relevancia clínica del índice avanzado de cáncer de pulmón, en pacientes con cáncer rectal.Un índice avanzado de cáncer de pulmón bajo, se correlacionó significativamente con la histología indiferenciada (p = 0.004), la progresión de la etapa T (p <0.001), la resección R1 / R2 para cirugía primaria (p = 0.004) y la metástasis a distancia (p <0.001). El análisis multivariante mostró que el índice avanzado de cáncer de pulmón bajo, era un factor pronóstico independiente, tanto para la supervivencia general (HR = 3.21 IC 95% 1.97-5.19 p <0.001) como para la supervivencia libre de enfermedad (HR = 2.13, IC 95% 1.23-3.63, p = 0,008), en pacientes con cáncer colorrectal. Además, la carga clínica del índice avanzado de cáncer de pulmón, fue consistente entre los sexos y su valor pronóstico se verificó clínicamente relevante, en pacientes con cáncer colorrectal en estadio III.El presente estudio tuvo varias limitaciones, incluyendo la observación retrospectiva y la pequeña muestra de pacientes japoneses, en una sola institución.El índice avanzado de cáncer de pulmón, podría ser un indicador pronóstico útil, en los resultados clínicos de pacientes sometidos a resección quirúrgica por cáncer colorrectal. Consulte Video Resumen http://links.lww.com/DCR/B267.

External validation of the prognostic relevance of the advanced lung cancer inflammation index (ALI) in pancreatic cancer patients

BACKGROUND

The advanced lung cancer inflammation index (ALI) was first introduced for prognosis prediction in lung cancer patients and since then evaluated in several other malignancies. However, in pancreatic cancer (PC) the ALI and its prognostic utility were only investigated in a comparably small and specific cohort of locally advanced PC patients treated with chemoradiotherapy.

METHODS

In our single-center cohort study, we included 429 patients with histologically verified PC who were treated between 2003 and 2015 at our academic institution. The ALI was defined as body mass index (BMI; kg/m2 ) × serum albumin levels (g/dL)/neutrophil-lymphocyte ratio (NLR) and we defined the optimal cutoff for biomarker dichotomization by ROC-analysis. Kaplan-Meier method as well as uni- and multivariate Cox regression Hazard proportional models were implemented to assess the prognostic potential of ALI in PC patients. We considered cancer-specific survival (CSS) as the primary endpoint of the study.

RESULTS

The ALI showed a significant negative correlation with CA19-9 levels and C-reactive protein levels whereas we found an association with localized tumor stage and better performance status (P < .05 for all mentioned variables). As opposed to patients with a high ALI, decreased ALI was significantly associated with shorter CSS (HR = 0.606, 95% CI: 0.471-0.779, P = .001). Multivariate analysis demonstrated tumor grade, tumor stage, chemotherapy, C-reactive protein levels, and CA19-9 levels to independently predict for CSS (all P < .05). In contrast the ALI failed to independently predict for CSS in the performed multivariate models (HR = 0.878, 95% CI: 0.643-1.198, P = .411).

CONCLUSION

In this large cohort of PC patients, the ALI did not complement existing clinicopathological factors for outcome determination.

Prognostic value of pre-treatment red blood cell distribution width in lung cancer: a meta-analysis

Objective: In recent years, increasing studies found that pre-treatment red blood cell distribution width (RDW) could predict clinical outcomes in various cancers. However, the prognostic value of pre-treatment RDW in lung cancer was inconsistent. Therefore, we performed a meta-analysis to determine prognostic value of pre-treatment RDW in lung cancer.Methods: We performed a search in PubMed, The Cochrane Library, EMBASE (via OVID), Web of Science, CNKI, Wanfang, VIP, SinoMed databases, then we identified all records up to February 15, 2019. Outcomes of interest were overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were calculated to assess the relevance of pre-treatment RDW to OS in lung cancer.Results: We included ten articles in total. Pooled results revealed that elevated pre-treatment RDW was significantly associated with poor OS (HR = 1.55, 95% CI: 1.26-1.92, p < 0.001) and DFS (HR = 1.53, 95% Cl: 1.15-2.05; p = 0.004) in lung cancer. Further subgroup analysis manifested that lung cancer patients with elevated pre-treatment RDW had worse prognosis.Conclusions: A higher value of pre-treatment RDW indicated worse survival of patients with lung cancer. RDW may serve as a reliable and economical marker for prediction of lung cancer prognosis.

Prognostic role of the advanced lung cancer inflammation index in cancer patients: a meta-analysis

Background

Inflammation plays a critical role in the development and progression of cancers. The advanced lung cancer inflammation index (ALI) is thought to be able to reflect systemic inflammation better than current biomarkers. However, the prognostic significance of the ALI in various types of cancer remains unclear. Our meta-analysis aimed to comprehensively investigate the relationship between the ALI and oncologic outcomes to help physicians better assess the prognosis of cancer patients.

Methods

The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for relevant studies. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated and pooled from the included studies. Furthermore, a sensitivity analysis was performed to evaluate the reliability of the articles. Finally, Begg’s test, Egger’s test, and the funnel plot were applied to assess the significance of publication bias.

Results

In total, 1736 patients from nine studies were included in our meta-analysis. The median cutoff value for the ALI was 23.2 (range, 15.5–37.66) in the analyzed studies. The meta-analysis showed that there was a statistically significant relationship between a low ALI and worse overall survival (OS) in various types of cancer (HR = 1.70, 95% CI = 1.41–1.99, P < 0.001). Moreover, results from subgroup meta-analysis showed that the ALI had a significant prognostic value in non-small cell lung cancer, small cell lung cancer, colorectal cancer, head and neck squamous cell carcinoma, and diffuse large B cell lymphoma (P < 0.05 for all).

Conclusions

These results showed that a low ALI was associated with poor OS in various types of cancer, and the ALI could act as an effective prognostic biomarker in cancer patients.

Prognostic Value of the Advanced Lung Cancer Inflammation Index in Patients with Lung Cancer: A Meta-Analysis

Background

The advanced lung cancer inflammation index (ALI) has been related to tumor survival in lung cancer (LC) patients. However, these findings regarding the prognostic relevance of ALI in LC were inconsistent. Our study is aimed at characterizing the prognostic significance of low pretreatment ALI in LC cases. Methods. Relevant published studies were systematically searched in several online databases. The combined hazard ratios (HRs) were applied to assess the correlation between ALI and overall/recurrence-free/progression-free survival (OS/PFS/RFS) in LC.

Results

A total of 1587 LC patients from eight articles were recruited. Pooled results indicated that pretreatment ALI was significantly associated with prognosis in cases with LC. Compared to those with high-ALI, LC cases in the low-ALI group had a poorer OS (HR: 1.64, 95% CI: 1.34-1.93, p < 0.001). Subgroup analyses further revealed the negative significant prognostic value of low ALI in LC. In addition, low ALI had obvious connection with inferior PFS/RFS (HR: 1.71, 95% CI: 1.35-2.07, p < 0.001) in LC patients.

Conclusions

Low ALI before treatments indicates poor prognosis in LC patients. Serum ALI may serve as a promising predictive tumor marker of survival in LC sufferers.