Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma

Giovanni Catalano; Laura Alaimo; Odysseas P Chatzipanagiotou; Andrea Ruzzenente; Federico Aucejo; Hugo P Marques; Vincent Lam; Tom Hugh; Nazim Bhimani; Shishir K Maithel; Minoru Kitago; Itaru Endo; Guillaume Martel; Carlo Pulitano; Feng Shen; Irinel Popescu; Bas Groot Koerkamp; Todd W Bauer; François Cauchy; George A Poultsides; Matthew Weiss; Ana Gleisner; Timothy M Pawlik

doi:10.1016/j.ejso.2024.108773

Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma

Eur J Surg Oncol. 2024 Dec;50(12):108773. doi: 10.1016/j.ejso.2024.108773. Epub 2024 Oct 18.

Authors

Giovanni Catalano¹, Laura Alaimo¹, Odysseas P Chatzipanagiotou², Andrea Ruzzenente³, Federico Aucejo⁴, Hugo P Marques⁵, Vincent Lam⁶, Tom Hugh⁷, Nazim Bhimani⁷, Shishir K Maithel⁸, Minoru Kitago⁹, Itaru Endo¹⁰, Guillaume Martel¹¹, Carlo Pulitano¹², Feng Shen¹³, Irinel Popescu¹⁴, Bas Groot Koerkamp¹⁵, Todd W Bauer¹⁶, François Cauchy¹⁷, George A Poultsides¹⁸, Matthew Weiss¹⁹, Ana Gleisner²⁰, Timothy M Pawlik²¹

Affiliations

¹ Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy.
² Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
³ Department of Surgery, University of Verona, Verona, Italy.
⁴ Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH, USA.
⁵ Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁶ Department of Surgery, Westmead Hospital, Sydney, Australia.
⁷ Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia.
⁸ Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
⁹ Department of Surgery, Keio University, Tokyo, Japan.
¹⁰ Yokohama City University School of Medicine, Yokohama, Japan.
¹¹ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
¹² Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
¹³ Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
¹⁴ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
¹⁵ Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
¹⁶ Department of Surgery, University of Virginia, Charlottesville, VA, USA.
¹⁷ Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France.
¹⁸ Department of Surgery, Stanford University, Stanford, CA, USA.
¹⁹ Department of Surgery, Cancer Institute, Northwell Health, NY, USA.
²⁰ Department of Surgery, UC Denver, Denver, CO, USA.
²¹ Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: [email protected].

PMID: 39447453
DOI: 10.1016/j.ejso.2024.108773

Abstract

Introduction: The advanced lung cancer inflammation index (ALI), which combines inflammation and nutrition data, was recently proposed as a prognostic biomarker. We assessed the impact of ALI on overall survival (OS) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC).

Methods: Patients who underwent surgery for ICC were identified from an international cohort. ALI was calculated as body-mass index (BMI)∗albumin/neutrophil-to-lymphocyte ratio; patients were categorized into "low-" and "high-ALI" using log-rank statistics. The impact of ALI on OS was compared against other inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII = platelets∗NLR]) using Harrell's Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences, propensity score matching was employed.

Results: Among 1045 patients, more than one-half of individuals underwent major hepatectomy (n = 582, 55.7 %), median tumor size was 5.5 cm (IQR, 3.8-7.8), and median ALI was 38.9 (IQR 26.5-57.2). On multivariate analysis, low ALI was an independent risk factor for worse OS (HR 1.21, 95 % CI 1.01-1.46; p = 0.04). Patients with low ALI had worse 5-year OS (36.9 % vs. 49.9 %; p < 0.001), which remained significant after PSM (36.9 % vs. 41.3 %; p = 0.039). ALI had a comparable discriminatory ability compared with NLR, PLR, and SII (C-index: 0.646 vs. 0.644 vs. 0.640 vs. 0.641, respectively), yet had a lower AIC (5475.31 vs. 5546.80 vs. 5550.45 vs. 5548.62, respectively) suggesting slightly better model fit and accuracy.

Conclusions: ALI was an independent predictor of OS among patients undergoing surgery for ICC. Nutritional and inflammatory markers should be incorporated into predictive models to improve prognostic stratification.

Keywords: Cancer surgery; Cholangiocarcinoma; Inflammation; Malnutrition.

MeSH terms

Aged
Bile Duct Neoplasms* / pathology
Bile Duct Neoplasms* / surgery
Body Mass Index
Cholangiocarcinoma* / pathology
Cholangiocarcinoma* / surgery
Female
Hepatectomy*
Humans
Inflammation*
Lymphocyte Count
Lymphocytes / pathology
Male
Middle Aged
Neutrophils*
Platelet Count
Prognosis
Propensity Score
Retrospective Studies
Serum Albumin / analysis
Serum Albumin / metabolism
Survival Rate

Substances

Serum Albumin