Abstract
BACKGROUND: Lung cancer is the leading cause of cancer-related death. Surgical resection of early-stage non-small cell lung cancer (NSCLC) is associated with a suboptimal survival rate and significant adverse outcomes. The advanced lung cancer inflammation index (ALI), which integrates body mass index (BMI), albumin level, and neutrophil-to-lymphocyte ratio (NLR), comprehensively assesses nutritional and inflammatory status, potentially improving prognostic precision in surgical patients. METHODS: This retrospective cohort study analyzed 2447 patients who underwent lung cancer resection (INSPIRE database, South Korea, 2011-2020). The ALI (BMI × Albumin/NLR) was calculated preoperatively. Patients were stratified into high (≥ 37.22) and low (< 37.22) ALI groups (receiver operating characteristic curve-determined cut-off). Associations between ALI and mortality (primary: 90-day; secondary: 180-day, in-hospital) were assessed using multivariate regression after adjusting for demographics, surgical factors, and key laboratory parameters. RESULTS: The low ALI group (n = 805) was older (64.2 vs 63.2 years, p = 0.018), had more males (63.2% vs. 51.2%, p < 0.001), and exhibited significantly poorer laboratory profiles (e.g., lower hematocrit and hemoglobin levels; higher white blood cell count and C-reactive protein levels; all p < 0.001) than the high ALI group (n = 1642). Mortality rates were significantly higher in the low ALI group (90-day: 1.6% vs 0.1%; 180-day: 3.2% vs 0.5%; in-hospital: 2.0% vs 0.4%; all p < 0.001). After full adjustment, compared with the low ALI group, the high ALI group had an 82% lower risk of 90-day mortality (HR 0.18, 95% CI 0.04-0.81) and a 70% lower risk of 180-day mortality (HR 0.30, 95% CI 0.13-0.70). Each 1-unit increase in ALI was linked to a 4% reduction in 90-day mortality risk (HR 0.96, 95% CI 0.93-0.99). High ALI was also associated with an 66% lower odds of in-hospital mortality (OR 0.34, 95% CI 0.12-0.96). CONCLUSIONS: Our study shows that ALI is significantly associated with poor clinical prognosis after lung cancer resection. The lower the ALI, the higher the 90-day, 180-day, and in-hospital mortality rates.