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Advanced Lung Cancer Inflammation Index has Prognostic Impact in Stage I Non-Small Cell Lung Cancer: A Registry-Based Analysis of 934 Patients

Year: 2025

Type: article

Abstract: Background The Advanced Lung Cancer Inflammation Index (ALI) has shown potential as a prognostic marker in lung cancer, but its role in early-stage non-small cell lung cancer (NSCLC) remains underexplored. This study evaluated the prognostic value of ALI in stage I NSCLC patients. Methods This registry-based study enrolled 934 stage I NSCLC patients diagnosed between 2015-2020 from the Danish Lung Cancer Registry (DLCR). Data from DLCR were merged with laboratory records. ALI was calculated as body mass index x albumin/neutrophil-to-lymphocyte ratio and dichotomized at the cohort median. Kaplan-Meier analysis (restricted mean survival time truncated at 6 years), Cox proportional hazards model, and C-statistics were used to assess the value of ALI on overall survival (OS) and disease-free survival (DFS). Results In patients receiving stereotactic radiation therapy (RT) (N=301), a significantly longer mean survival was observed in the high ALI group compared with the low ALI group (5.12 vs. 4.81 years; P = 0.040). Multivariate analysis confirmed ALI as an independent prognostic factor for OS (HR 0.70, 95% CI: 0.51–0.96). No significant association with DFS was observed. In the surgically treated patients (N=633), ALI was not associated with OS or DFS. C-statistics demonstrated that adding ALI significantly improved prognostic models for OS but not DFS independent of treatment. Conclusion ALI is an independent prognostic factor for OS in stage I NSCLC patients treated with stereotactic RT, but not in surgically treated patients. Incorporating ALI into prognostic models improved OS prediction, supporting its role as a simple biomarker in early-stage NSCLC. Microabstract This registry-based study evaluated the prognostic value of the Advanced Lung Cancer Inflammation Index (ALI) in 934 patients with stage I non-small cell lung cancer (NSCLC). Analyses were stratified by treatment modality. A low ALI at diagnosis was independently associated with worse overall survival (OS) in patients treated with stereotactic radiotherapy, while no significant association was observed in surgically treated patients. ALI was not significantly associated with disease-free survival (DFS) in either group. These findings suggest that ALI may serve as a prognostic biomarker, particularly among patients receiving radiotherapy for early-stage NSCLC.

Source: Clinical Lung Cancer

DOI: 10.1016/j.cllc.2025.10.013

Authors: Camilla Højbjerg Gregersen, Ninna Aggerholm-Pedersen, Birgitte Sandfeld-Paulsen, Anne Winther-Larsen

Institutions: Aarhus University Hospital, Aalborg University Hospital

Language: English

Topic: Inflammatory Biomarkers in Disease Prognosis

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,200