G. Catalano1,2, L. Alaimo2, O.P. Chatzipanagiotou1, A. Ruzzenente2, F. Aucejo3, H.P. Marques4, V. Lam5, T. Hugh6, N. Bhimani6, S.K. Maithel7, M. Kitago8, I. Endo9, G. Martel10, C. Pulitano11, F. Shen12, S. Alexandrescu13, B. Koerkamp19, T.W. Bauer14, F. Cauchy15, G.A. Poultsides16, M. Weiss17, A. Gleisner18, T.M. Pawlik1 1Ohio State University, Department Of Surgery, Columbus, OH, USA 2University of Verona, Department Of Surgery, Verona, ITALY, Italy 3Cleveland Clinic, Department Of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH, USA 4Curry Cabral Hospital, Department Of Surgery, Lisbon, PORTUGAL, Portugal 5Westmead Hospital, Department Of Surgery, Sydney, AUSTRALIA, Australia 6The University of Sydney, Department Of Surgery, Sydney, AUSTRALIA, Australia 7Emory University School Of Medicine, Division Of Surgical Oncology, Atlanta, GA, USA 8Keio University, Department Of Surgery, Tokyo, JAPAN, Japan 9Yokohama City University School of Medicine, Department Of Surgery, Yokohama, JAPAN, Japan 10University Of Ottawa, Department Of Surgery, Ottawa, Ontario, Canada 11Royal Prince Alfred Hospital, Department Of Surgery, Sydney, AUSTRALIA, Australia 12Eastern Hepatobiliary Surgery Hospital, Department Of Surgery, Shanghai, CHINA, China 13Fundeni Clinical Institute, Department Of Surgery, Bucharest, ROMANIA, Romania 14University Of Virginia, Department Of Surgery, Charlottesville, VA, Virgin Islands, U.S. 15Beaujon Hospital, Department Of Hepatobiliopancreatic Surgery And Liver Transplantation, Clichy, FRANCE, France 16Stanford University, Department Of Surgery, Palo Alto, CA, USA 17Johns Hopkins University School Of Medicine, Department Of Surgery, Baltimore, MD, USA 18University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA 19Erasmus University Medical Center Rotterdam, Department Of Surgery, Rotterdam, Rotterdam, Netherlands
Introduction: Cancer-related inflammation and malnutrition may impact the long-term outcomes of patients with cancer. Recently, the advanced lung cancer inflammation index (ALI), which combines data on inflammation and nutrition, was proposed as a prognostic biomarker. We sought to define the impact of ALI on overall survival (OS) among patients undergoing curative-intent surgical resection of intrahepatic cholangiocarcinoma (ICC).
Methods: Patients who underwent resection of ICC between 2000 and 2022 were identified using a multi-center international database. ALI was calculated as body-mass index (BMI) * albumin / neutrophil-to-lymphocyte ratio; patients were subsequently categorized into “low-” and “high-ALI” using the maximally selected rank statistics. The impact of ALI on OS was assessed and compared against other previously validated inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and systemic immune inflammation index [SII = platelets ∗ NLR]) using Harrell’s Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences related to preoperative and postoperative patient and tumor characteristics, propensity score matching (PSM) analysis was employed.
Results: Among 1,045 individuals in the analytic cohort, median patient age was 61 years (IQR: 52.0-69.0) and the majority was male (n=614; 58.8%); median BMI was 25.1 (IQR: 22.3–28.2) kg/m2. Most patients had a single ICC tumor (n=910, 87.1%) and median tumor size of the largest lesion was 5.5 (IQR 3.8–7.8) cm; median tumor burden score was 5.69 (IQR 4.0–8.1). Median preoperative ALI was 38.9 (IQR 26.5-57.2) (low ALI, n=379; high ALI, n=666). Of note, patients with low ALI had a worse 5-year OS (low: 36.9% vs. high: 49.9%; p<0.001). On multivariate analysis, low ALI remained an independent risk factor for worse OS (HR 1.24, 95%CI 1.01-1.50; p=0.03). ALI also remained associated with worse long-term survival after PSM (low: 37.0% vs. high: 41.3%; p<0.001) (Figure). ALI had a comparable discriminatory ability to other inflammatory markers such as NLR, PLR, and SII (C-index: 0.668 vs. 0.667 vs. 0.666 vs. 0.666, respectively), yet had a lower AIC (AIC: 5475.75 vs. 5526.71 vs. 5527.71 vs. 5525.94, respectively) suggesting slightly better model fit and predictive accuracy.
Conclusion: ALI was an independent predictor of OS among patients who underwent curative-intent resection of ICC. Incorporating indicators of nutritional and inflammatory status in prognostic models may assist with prognostic stratification of patients undergoing cancer-related surgery.