Advanced lung cancer inflammation index (ALI) as a prognostic marker for locally advanced and metastatic cancer: A prospective study.

e20513 Background: We developed ALI as a prognostic marker (ALI <18 = poor prognosis, ALI ≥ 18=good prognosis) for patients with metastatic non-small cell lung cancer. It has been validated by dozens of studies in a variety of cancer types, though the optimal cut off varies between the studies. To further define optimal cutoff values for ALI in different cancers, we redefined ALI into three different categories and evaluated its prognostic significance in a prospective data set of patients with advanced cancer and cancer cachexia. Methods: We enrolled patients with locally advanced or metastatic solid tumors with cancer cachexia between 2020 and 2024 as part of an ongoing study of detecting biomarkers of cancer cachexia. Patient's body mass index (BMI), serum albumin (Alb) and neutrophil to lymphocyte ratio (NLR) at diagnosis were used to calculate ALI (BMI x Alb/NLR). Patients were categorized into three risk groups based on ALI levels at diagnosis: good risk (ALI: > 16), intermediate risk (ALI: 5.1 – 16), and poor risk (ALI: ≤ 5). We used hazard ratio and Kaplan-Meier survival curves to estimate the survival probability and association between ALI and all-cause mortality. Results: A total of 105 patients with complete medical information were enrolled in the final analysis, including patients with lung cancer (n=47), gastrointestinal cancers (n=40) and other cancer type (n=18). Majority of the patients had either stage (IV ) 82 (78%) or Stage III disease 21 (20%), and 2 patients (2%) had stage II disease. Among the patients, 48.5% (n = 50) were classified as low risk, 38.8% (n = 40) as intermediate risk, and 12.6% (n = 13) as poor risk. There were no statistically significant differences in gender, ethnicity, or cancer type among the three risk groups. Patients with ALI >16 had a significantly lower unadjusted hazard of mortality (HR = 0.29, 95% CI: 0.14 – 0.64) compared to those with ALI <5. In an adjusted analysis, patients with ALI >16 (good risk) (aHR = 0.180, 95% CI: 0.06 – 0.55) and ALI 5.1-16 (intermediate risk) (aHR = 0.30, 95% CI: 0.11 – 0.80) had a significantly lower adjusted hazard of mortality as compared to patients with ALI <5 (poor risk) after controlling for all other factors. Based on the Kaplan-Meier survival probabilities, patients with ALI >16 (median overall survival (OS) = 18 months) and ALI 5.1-16 (OS = 6 months) had a significantly better OS than ALI <5 (OS=3 months) with a log-rank p-value of 0.003. Conclusions: ALI is a very useful prognostic clinical biomarker for cancer patients which has been validated in a number of studies. Categorizing it into three risk groups further refines its prognostic utility. ALI can be used in research and clinical practice to risk stratify patients with locally advanced and metastatic solids tumors of any type.