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

Figures & data

Table 1 Clinical Characteristics of Patients

	Baseline	No.
Age	<65 years	31
	≥65 years	17
Gender	Male	34
	Female	14
Smoking	Never	23
	Current/ever	25
BMI	<18.5	2
	≥18.5 to <25	23
	≥25	23
PS	0–1	33
	2	15
CCI	0	19
	1–2	13
	≥3	16
ALB (g/dL)	<4.13	23
	≥4.13	25
WBC (×10^9/L)	<6.47	23
	≥6.47	25
RBC (×10^12/L)	<4.30	15
	≥4.30	33
PLT (×10^9/L)	<231.50	24
	≥231.50	24
MONO (×10^9/L)	<0.38	31
	≥0.38	17
EO (×10^9/L)	<0.12	28
	≥0.12	20
BASO (×10^9/L)	<0.05	38
	≥0.05	10
NLR	<2.08	20
	≥2.08	28
LMR	<10.86	46
	≥10.86	2
PLR	<124.27	22
	≥124.27	26
Pro-GRP	Normal	3
	High	21
NSE	Normal	28
	High	20
Postoperative chemotherapy	Yes	33
	No	15

Abbreviations: BMI, body mass index; PS, performance status; CCI, Charlson comorbidity index; ALB, albumin count; WBC, white blood cell count; RBC, red blood cell count; PLT, platelet count; MONO, monocyte count; EO, eosinophil count; BASO, basophil count; NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; PLR, platelet to lymphocyte ratio; ALI, advanced lung cancer inflammation index; CEA, carcinoembryonic antigen; LDH, lactate dehydrogenase; SCC, squamous cell carcinoma antigen; CYFRA 21-1, cytokeratin-19 fragment; Pro-DRP, pro-gastrin releasing peptide; NSE, neuron-specific enolase; CRP, C-reactive protein.

Table 2 Relationship Between Patient Characteristics and ALI

	Baseline	ALI<48.2	ALI≥48.2	P value
		n=25	n=23
Age	<65 years	15	16	0.349
	≥65 years	10	7
Gender	Male	18	16	0.552
	Female	7	7
Smoking	Never	10	13	0.196
	Now or ever	15	10
PS	0–1	11	22	<0.001
	2	14	1
CCI	0	7	12	<0.05
	1–2	6	7
	≥3	12	4
BMI	<18.5	2	0	0.086
	≥18.5 to <25	13	9
	≥25	10	14
ALB (g/dL)	<4.13	13	10	0.382
	≥4.13	12	13
WBC (×10^9/L)	<6.47	11	12	0.391
	≥6.47	14	11
RBC (×10^12/L)	<4.30	7	8	0.422
	≥4.30	18	15
PLT (×10^9/L)	<231.50	13	11	1
	≥231.50	12	12
MONO (×10^9/L)	<0.38	17	14	0.415
	≥0.38	8	9
EO (×10^9/L)	<0.12	13	15	0.263
	≥0.12	12	8
BASO (×10^9/L)	<0.05	22	16	0.112
	≥0.05	3	7
NLR	<2.08	13	7	0.111
	≥2.08	12	16
LMR	<10.86	24	22	0.734
	≥10.86	1	1
PLR	<124.27	14	8	0.118
	≥124.27	11	15
CRP	Normal	8	19	<0.001
	High	17	4
CEA	Normal	14	17	0.160
	High	11	6
LDH	Normal	13	19	<0.05
	High	12	4
SCC	Normal	12	11	0.592
	High	6	6
CYFRA21-1	Normal	9	16	<0.05
	High	7	16
Pro-GRP	Normal	1	2	0.249
	High	15	6
NSE	Normal	14	14	0.481
	High	9	11
Postoperative chemotherapy	Yes	9	6	0.335
	No	16	17
Living status	Live	17	15	0.540
	Death	8	8

Abbreviations: BMI, body mass index; PS, performance status; CCI, Charlson comorbidity index; ALB, albumin; WBC, white blood cell; RBC, red blood cell; PLT, platelet; MONO, monocyte; EO, eosinophil; BASO, basophil; NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; PLR, platelet to lymphocyte ratio; ALI, advanced lung cancer inflammation index; CEA, carcinoembryonic antigen; LDH, lactate dehydrogenase; SCC, squamous cell carcinoma antigen; CYFRA 21–1, cytokeratin-19 fragment; Pro-GRP, pro-gastrin releasing peptide; NSE, neuron-specific enolase; CRP, C-reactive protein.

Figure 1 Receiver operating characteristic (ROC) curves. (A) shows the ROC curve of advanced lung cancer inflammation index (ALI). The maximum Youden index is 0.094, corresponding optimal cutoff value of ALI is 48.2. (B) shows the ROC curves of red blood cell count (RBC), white blood cell count (WBC), platelet count (PLT), monocyte count (MONO), eosinophil count (EO), basophil count (BASO), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR) and serum albumin (ALB). Maximum Youden indexes are as follows: 0.375 for RBC, 0.531 for WBC, 0.094 for PLT, 0.500 for MONO, 0.313 for EO, 0.438 for BASO, 0.063 for LMR, 0.063 for PLR, 0.125 for NLR and 0.250 for ALB. Optimal cutoff points of RBC (×10¹²/L), WBC (×10⁹/L), PLT (×10⁹/L), MONO (×10⁹/L), EO (×10⁹/L), BASO (×10⁹/L), LMR, PLR, NLR and ALB (g/dL) are 4.30, 6.47, 231.50, 0.38, 0.12, 0.45, 10.86, 124.27, 2.08 and 4.13.

Figure 2 Patient overall survival (OS) curves following surgery. The curves indicate that high ALI group (ALI≥48.2) shows more survival rates and longer survival time (P<0.05).

Table 3 Univariable and Multivariable Analysis

	Univariable Analysis				Multivariable Analysis
	P value	HR	95% CI		P value	HR	95% CI
			LL	UL			LL	UL
ALI	0.031	0.309	0.107	0.896	0.009	0.035	0.003	0.425
Gender	0.070	53.193	0.722	3918.139	0.952	260,285.584	0
Age	0.505	1.454	0.484	4.370
Smoking	0.005	6.280	1.750	22.534	0.538	0.492	0.051	4.704
PS	0.019	0.276	0.094	0.809
CCI=0	0.011				0.137
CCI=1-2	0.936	0.943	0.225	3.949	0.310	3.644	0.301	44.150
CCI≥3	0.006	7.011	1.739	28.267	0.046	9.355	1.037	84.381
ALB	0.675	1.236	0.458	3.336
WBC	0.669	0.806	0.299	2.170
RBC	0.093	43.222	0.534	3495.431	0.955	292,578.176	0
PLT	0.487	1.421	0.528	3.826
MONO	0.001	6.590	2.067	21.015	0.073	0.225	0.044	1.151
EO	0.023	3.562	1.194	10.632	0.094	5.371	0.750	38.493
BASO	0.012	3.711	1.335	10.314	0.475	0.567	0.120	2.685
NLR	0.069	0.384	0.137	1.079	0.323	2.090	0.484	9.022
LMR	0.567	0.045	0	1813.598
PLR	0.393	0.650	0.242	1.747
CEA	0.745	1.184	0.427	3.289
LDH	0.046	2.867	1.017	8.079	0.826	0.783	0.089	6.881
SCC	0.556	1.533	0.370	6.359
CYFRA21-1	0.127	2.284	0.790	6.599
NSE	0.152	2.074	0.765	5.624	0.329	0.319	0.032	3.156
BMI<18.5	0.243
BMI[18.5,25)	0.797	0.745	0.079	7.037
BMI≥25	0.114	2.383	0.812	6.991
CRP	0.926	1.053	0.357	3.103
Pro-GRP	0.960	0.946	0.110	8.136
Postoperative chemotherapy	0.644	0.775	0.263	2.283

Abbreviations: ALI, advanced lung cancer inflammation index; PS, performance status; CCI, Charlson comorbidity index; ALB, albumin; WBC, white blood cell; RBC, red blood cell; PLT, platelet; MONO, monocyte; EO, eosinophil; BASO, basophil; NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; PLR, platelet to lymphocyte ratio; CEA, carcinoembryonic antigen; LDH, lactate dehydrogenase; SCC, squamous cell carcinoma antigen; CYFRA 21–1, cytokeratin-19 fragment; NSE, neuron-specific enolase; BMI, body mass index; CRP, C-reactive protein; Pro-GRP, pro-gastrin releasing peptide.