Inflammation-Based Prognostication in Extensive-Stage Small Cell Lung Cancer in the First-Line Setting: The Advanced Lung Inflammation Index and the Others.

Abstract

Objective: This study aimed to investigate the prognostic significance of inflammatory indices, including the advanced lung inflammation index (ALI), in extensive-stage small cell lung cancer (ES-SCLC) patients receiving first-line platinum-etoposide chemotherapy.

Methods: The study included 167 ES-SCLC patients. Patients with confirmed ES-SCLC histology who had completed at least 2 months of first-line treatment (platinum etoposide chemotherapy regimen without immunotherapy) were included. Demographic information, clinicopathological characteristics, and blood parameters (blood test results between Days 1 and 7 before the first chemotherapy) of the patients before the first treatment were recorded from the electronic record system.

Results: Median age was 62 years (range: 40-88 years). A total of 163 (97.6%) patients had died of cancer-related causes. For all patients, the median OS (mOS) was 9 (95% CI: 8-10) months. In univariate analysis, gender, age, smoking, BMI, brain metastasis status, bone metastasis status, PCI (prophylactic cranial irradiation), and SVCSS (superior vena cava syndrome) were not associated with survival. Poor performance status (p = 0.036), low C-reactive protein-albumin-lymphocyte index (CALLY) (p = 0.030), high systemic immune inflammation index (SII) (p = 0.042), and low ion index (ALI) (p = 0.016) were predictive of poor survival on univariate analysis. Factors found to be prognostic in univariate analysis were evaluated in multivariate analysis. In the established model, only ALI (HR = 0.68, 95% CI: 0.49-0.93, p = 0.016) were found to be an independent prognostic factor for OS. The corresponding mOS according to CALLY, SII, ALI, and ECOG (Eastern Cooperative Oncology Group - Performance score) performance status were 8 versus 10 months (p = 0.020), 10 versus 8 months (p = 0.030), 8 versus 9 months (p = 0.010), and 9 versus 8 months (p = 0.025), respectively, with significant difference.

Conclusion: CALLY, SII, ALI, and ECOG performance status could be useful prognostic markers for clinicians in patients with ES-SCLC receiving chemotherapy, with ALI emerging as the strongest prognostic factor. These readily accessible and easily computed markers can facilitate cost-effective follow-up and treatment decision-making by providing clinicians with a real-time assessment of the dynamic balance between host immunity and tumor-associated inflammation.