Prognostic value of the advanced lung cancer inflammation index in patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma

The advanced lung cancer inflammation index (ALI), which integrates nutritional and inflammatory indicators, has been associated with outcomes in several malignancies. This study evaluates the predictive efficacy of ALI in patients undergoing curative-intent surgery for intrahepatic cholangiocarcinoma (ICC). Patients undergoing curative-intent resection for ICC from a multi-institutional database were stratified into low- and high-ALI groups, with propensity score matching (PSM) applied to reduce baseline differences. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regression models identified independent factors associated with overall survival (OS), and P values were adjusted using the Benjamini–Hochberg false discovery rate (FDR) method. The cohort was randomly split into training ( n = 464) and validation ( n = 227) datasets to construct and validate an ALI-based dynamic online nomogram. Prognostic performance was assessed using the concordance index (C-index), time-dependent ROC curves, and decision curve analysis (DCA). A total of 691 patients were included, of whom 194 (28.1%) had low ALI (≤ 27.6) and 497 (71.9%) had high ALI (> 27.6). Patients with low ALI had poorer 5-year OS than those with high ALI (20.2% vs. 45.7%, P < 0.001), and the difference remained significant after PSM (20.2% vs. 42.3%, P < 0.001). Low ALI was independently associated with mortality before (HR 1.54, 95% CI 1.25–1.90, P < 0.001) and after matching (HR 1.59, 95%CI 1.24–2.04, P < 0.001). Compared with 11 alternative indices, ALI showed the highest prognostic discrimination for OS (5-year C-index: 0.763). The ALI-based nomogram showed good calibration and yielded significantly superior C-index, AUC, and DCA net benefits compared to the AJCC 8th edition TNM stage, Hyder nomogram, and MEGNA score in both the training and validation cohorts. ALI was independently associated with overall survival after curative-intent resection for ICC and showed greater prognostic discrimination than other evaluated indices. Incorporation of ALI into prognostic assessment may assist preoperative risk stratification.