Predictive Value of Advanced Lung Cancer Inflammation Index and Development of a Nomogram for Prognosis in Patients with Cervical Cancer Treated with Radiotherapy

Qiong Yu,1,&ast; Yiwen Sun,2,&ast; Shuaishuai Zhang,3 Xintian Xu,4 Guoliang Pi,5 Xin Jin4 1Department of Digestive Medicine, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, People’s Republic of China; 2Information Statistics Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 3Department of Oncology, SuiZhou Hospital, Hubei University of Medicine, Suizhou, Hubei, People’s Republic of China; 4Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 5Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guoliang Pi, Email [email protected] Xin Jin, Email [email protected]: As an assessment tool of nutritional status and inflammation, the advanced lung cancer inflammation index (ALI) is associated with survival in various cancers. We aimed to investigate the association between the ALI’s prognostic value and survival time in patients with the stage IIB–III cervical cancer treated with radiotherapy.Patients and Methods: We retrospectively screened patients diagnosed with cervical cancer and underwent radiotherapy in a single institution between September 2013 to September 2015. The ALI was calculated as body mass index &ast; serum albumin/neutrophil-to-lymphocyte ratio. The cut-off value of ALI was determined by the receiver operating characteristic (ROC) curves. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method and Cox proportional hazards models. A nomogram was developed using prognostic factors based on multivariate analyses.Results: A total of 178 patients with cervical cancer were included. The cutoff value of ALI was set at 310.6 by ROC analyses. Kaplan Meier survival curves indicated that patients with low ALI had a significantly poorer OS (log-rank P< 0.001) and PFS (log-rank P=0.0056) than those with high ALI. The association between ALI and OS was significant in the patients with obese/overweight and low/normal weight. The Cox regression analysis indicated that patients with low ALI were associated with a decreased OS (Hazard Ratio (HR) = 2.56, 95% Confidence Intervals (CI), 1.35– 4.83; P= 0.004) and PFS (HR = 1.83; 95% CI, 1.06– 3.17; P = 0.031). The nomogram on OS was created based on ALI with C-index of 0.81. Patients with high nomogram points had worse OS than those with low nomogram points (log rank P< 0.0001).Conclusion: Pretreatment ALI is an independent negative prognostic factor in patients with cervical cancer treated with radiotherapy. The ALI based nomogram can help to identify patients who may have unfavorable outcomes.Keywords: cervical cancer, prognosis, survival, advanced lung cancer inflammation index