Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review

Abstract

BackgroundSystemic inflammation has been linked with cancer development, cancer cachexia and poor outcome. Advanced lung cancer inflammation index (ALI) was developed to assess degree of systemic inflammation at the time of diagnosis in metastatic non-small cell lung (NSCLC) cancer patients.MethodsIn a single institution retrospective review 173 patients with metastatic NSCLC diagnosed between Jan 1 2000 and June 30 2011 were included. ALI was calculated as (BMI x Alb / NLR) where BMI = body mass index, Alb = serum albumin, NLR (neutrophil lymphocyte ratio, a marker of systemic inflammation). Patients were divided into low inflammation (ALI ≥ 18) and high inflammation (ALI < 18) groups. Kaplan-Meier method was used to estimate progression free survival and overall survival. Log-rank test were used to compare the survivals among various factors. Multivariate Cox regression was used to perform survival analysis in order to estimate the hazards ratio for various factors.ResultsAmong 173 patients median age was 57 years, 67% were male, 52% had adenocarcinoma. Patients with an ALI score of < 18 suggesting high systemic inflammation were significantly more likely to have more than 2 sites of metastatic disease, have poor performance status and less likely to receive any chemotherapy. Their median progression free survival and overall survival was 2.4 months and 3.4 months as opposed to 5.1 months and 8.3 months in patients with ALI >18 (P < 0.001). On multi-variate analysis ALI score of <18 (1.42, 95% CI 1.003-2.01) remained significantly associated with worse outcome.ConclusionALI (<18) at diagnosis is an independent marker of poor outcome in patients with advanced NSCLC.

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

“…The authors suggested that albumin and LDH levels might be used in the risk scoring in further studies. Further studies demonstrated that serum albumin level was a critical prognostic factor in the lung cancer (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014). In these studies, prognostic risk models were created using a number of clinical and laboratory variables and low serum albumin level was found to be one of the poor prognostic factors in the majority of the scoring systems.…”

“…With the introduction of recent findings, the Glasgow Prognostic Score (GPS) and the Advanced Lung Cancer Inflammation Index (ALI) on the basis of serum albumin and CRP level have been developed. In addition, further scoring systems such as modified-GPS, Prognostic Index (PI), Adverse Prognostic Factors (APF), and the Montreal Prognostic Score (MPS) based on the performance status, CRP, tumor markers such as carbohydrate antigen (CA)-125, and inflammatory markers such as leukocycte and neutrophil/lymphocyte ratio have been developed (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014). In the majority of these studies, many patients had a metastatic disease (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014).…”

Anti-cancer activity of dose-fractioned mPE +/− bevacizumab regimen is paralleled by immune-modulation in advanced squamous NSLC patients

“…bias does exist, due to both the small statistical sample of the patients and the retrospective nature of our analysis, these results appear promising considering that the most commonly used chemotherapy doublets induce in these patients a response rate of 25-40% and a median survival no longer than 9-10 months (4,6). In particular, we found that a systemic baseline inflammatory profile characterized by a low LNR, low levels of IL-17A and T reg s, and a high baseline expression of active DCs (CD83 + ), is predictive of longer survival (19)(20)(21). It has been proposed that a chronic inflammation status supports tumor progression by increasing growth factors, chemokines and cytokines; they also promote inflammation-related neo-angiogenesis and both homing and differentiation of immunesuppressive cell lineages like myeloid derived suppressive cells (MDSCs) and T reg s (21-25).…”

Contrast‑enhanced computerized tomography combined with a targeted nanoparticle contrast agent for screening for early‑phase non‑small cell lung cancer

“…Hence, different diagnostics tools for patients with NSCLC have been explored (11,18). Clinically, computerized tomography (CT) scanning is frequently used to diagnose NSCLC (19). Subsequently, histopathology is applied to confirm the final diagnosis (20).…”