The Usefulness of the Modified Advanced Lung Cancer Inflammation Index (mALI) as a Prognostic Factor in Patients With Esophageal Cancer who Have Undergone Curative Resection.

Abstract

Background/aim: In several previous studies, the modified advanced lung cancer inflammation index (mALI) has been reported to be a useful prognostic factor in non-small cell lung cancer. This study aimed to demonstrate the relationship between mALI and the oncological prognosis of patients with esophageal cancer (EC) who underwent curative treatment and to clarify the underlying mechanism.

Patients and methods: We retrospectively followed up patients who underwent curative resection of esophageal cancer at Yokohama City University between 2000 and 2020 and extracted clinical data from their medical records. mALI was defined as follows: mALI=[L3 muscle index (L3MI) (cm²/m²)×albumin (g/l)]/neutrophil-to-lymphocyte ratio (NLR) [neutrophil count÷lymphocyte count].

Results: A total of 196 patients were selected for this study, and the cutoff value for mALI was set separately for male and females. When the cutoff value was set at 10 for males and 12 for females, 84 patients were assigned to the mALI-low group and 112 patients were assigned to the mALI-high group. A survival analysis revealed that the 5-year overall survival (OS) rate was 50.3% in the mALI-low group and 62.5% in the mALI-high group (p=0.014). A multivariate analysis of OS revealed that mALI was an independent prognostic factor. The 5-year recurrence-free survival (RFS) rates were 33.0% in the mALI-low group and 44.9% in the mALI-high group (p=0.044). The multivariate analysis of RFS revealed that mALI was an independent prognostic factor. In addition, the mALI-low group had a higher rate of hematogenous metastasis than the mALI-high group.

Conclusion: mALI is associated with the oncological prognosis of patients with EC who have undergone radical resection via several mechanisms and is a useful prognostic factor.