Combination of albumin-lymphocyte score and skeletal muscle index predicts prognosis of patients with ovarian cancer after primary debulking surgery

Purpose: Accumulating evidence underscores the significance of inflammation and nutrition in tumor progression. Although low albumin-lymphocyte score (ALS) and skeletal muscle index (SMI) are known to be associated with negative outcomes in patients with ovarian cancer (OC) undergoing primary debulking surgery, the usefulness for predicting prognosis remains unclear. We aimed to assess the relevant preoperative prognostic variables and their combined impact on patients with OC. Methods: This retrospective study included 347 patients with primary OC from multiple medical centers. The patients were divided into discovery (237 patients) and validation (110 patients) cohorts. Serological tests and plain computed tomography were performed to quantify the ALS and SMI. We investigated the preoperative prognostic ability of a unique index based on a combination of ALS and SMI, the CAS grade. Results: Patients with a lower ALS and a higher SMI showed improved overall survival (OS) and recurrence-free survival (RFS). Upon stratification by CAS grade, grade 1 patients demonstrated the highest body mass index and the most favorable survival prognosis, whereas grade 3 patients demonstrated the poorest OS and RFS. The independent variables for OS and RFS included residual disease and elevated CAS grade. These findings were validated in an independent cohort study. Conclusion: The CAS grade, a combination of ALS and SMI, is a meaningful and independent predictor of prognosis in patients with OC.