ADVANCED LUNG CANCER INFLAMMATION INDEX PREDICTS OUTCOME OF PATIENTS WITH COLORECTAL CANCER AFTER SURGICAL RESECTION
Kurando Kusunoki*, Yuji Toiyama, Yoshinaga Okugawa, Akira Yamamoto, Yusuke Omura, Chengzeng Yin, Shozo Ide, Takahito Kitajima, Hiroyuki Fujikawa, Hiromi Yasuda, Junichiro Hiro, Shigeyuki Yoshiyama, Masaki Ohi, Toshimitsu Araki, Masato Kusunoki
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Japan, Tsu, Mie, Japan
ABSTRACT
Background
Recently, index for assessment of host-nutrition status are collecting a lot of attention as an indicator for predicting prognosis with several malignant tumors. Emerging evidences revealed advanced lung cancer inflammation index (ALI index) as a useful prognostic indicator with clinical outcomes in patients with non-small cell lung cancer and several other malignancies. However, the prognostic value of preoperative ALI index for patients with colorectal cancer (CRC) remains unclear. The aim of this study was to evaluate the prognostic value of ALI index in CRC patients after surgery.
Patients and Methods
A total 298 patients (male:171 patients; female:127 patients) who underwent surgical treatment with primary CRC at our institute were enrolled in this study. ALI index was calculated as follows: ALI=Body math index(BMI)×Alb / Neutrophil lymphocyte ratio (NLR). As the cut-off point for ALI index was defined as 1st quartile, we divided all CRC patients among 2 groups using the cut-off point. We analyzed oncological outcome of 2 groups, using statistical methods.
Results
Low ALI index was significantly correlated with well-established clinicopathological factors, including undifferentiated histology (p=0.004), advanced T stage (p<0.001), presence of vessel invasion (p=0.037) and distant metastasis (p<0.001) in CRC patients. Patients with decreased ALI index for CRC showed poorer prognosis than those with high ALI index in terms of overall survival (OS) (log-rank test, p<0.001) and disease free survival (DFS) (log-rank test, p=0.002). Multivariate Cox's regression analysis decreased that low ALI index was an independent prognostic factor for both OS (HR=3.04 95%CI 1.87-4.91 P<0.001) and DFS (HR=1.88 95%CI 1.11-3.08 p=0.019). Especially in clinically relevant Stage III CRC patients who need to receive postoperative adjuvant chemotherapy, decreased ALI index was significantly correlated with poor prognosis in terms of both OS (log-rank test, p<0.001) and DFS (log-rank test, p=0.002). Cox proportional hazards analysis revealed that low ALI index was an independent prognostic factor for both OS and DFS in stage III CRC patients (OS: HR=4.86 95%CI 1.87-12.6 p=0.002, DFS: HR=2.13 95%CI 0.99-4.51 p=0.05).
Conclusions
Our study highlights that ALI index could be a useful prognostic indicator with clinical outcomes in patients who underwent surgical resection with CRC. Assessment of preoperative ALI index might support the early detection/prediction of recurrence, and may contribute to risk stratification of oncological outcomes especially in clinically relevant stage III CRC patients.
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