Combined influence of nutritional and inflammatory status on mortality in cancer survivors complicated with cardiovascular disease

The advanced lung cancer inflammation index (ALI) reflects systemic inflammatory and nutritional status, both of which are related to the prognosis of the disease. However, the prognostic value of ALI in cancer survivors with cardiovascular disease (CVD) remains unclear. This study was conducted to investigate the association of ALI with mortality in cancer survivors with CVD. This study enrolled 955 cancer survivors with CVD from the National Health and Nutrition Examination Survey (NHANES, 1999–2018), and followed mortality status until December 31, 2019. Cox proportional hazards regression analysis and threshold effect analysis were applied to evaluate the relationship between ALI and all-cause, CVD-specific, and cancer-specific mortality. The prognostic value of ALI was further examined by time-dependent receiver operating characteristic (ROC) curve analysis. During a median follow-up period of 66.65 months, 490 all-cause deaths were observed, including 181 CVD-specific deaths and 121 cancer-specific deaths. After multivariate adjustment, ALI was inversely associated with all-cause, CVD-specific, and cancer-specific mortality in cancer survivors with CVD. Furthermore, L-shaped associations of ALI with mortality were discovered, with inflection points of 74.18 for all-cause and CVD-specific mortality and 55.50 for cancer-specific mortality. When the ALI was less than the inflection points, a 10-unit increase of ALI was associated with a 16%, 16%, and 25% decreased HR for all-cause, CVD-specific, and cancer-specific mortality, respectively. The time-dependent ROC curve analysis showed that the ALI had moderate predictive value for short- and long-term mortality. The ALI is a significant prognostic indicator of mortality for cancer survivors with CVD. The findings indicate the potential clinical value of monitoring and evaluating the ALI in preventing mortality in cancer survivors with CVD.