Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):879-890. doi: 10.1002/jcsm.13205. Epub 2023 Mar 5.
Changes in body composition and systemic inflammation are important characteristics of cancer cachexia. This multi-centre retrospective study aimed to explore the prognostic value of the combination of body composition and systemic inflammation in patients with cancer cachexia.
The modified advanced lung cancer inflammation index (mALI), which combines body composition and systemic inflammation, was defined as appendicular skeletal muscle index (ASMI) × serum albumin/neutrophil-lymphocyte ratio. The ASMI was estimated according to a previously validated anthropometric equation. Restricted cubic splines were used to evaluate the relationship between mALI and all-cause mortality in patients with cancer cachexia. Kaplan-Meier analysis and Cox proportional hazard regression analysis were used to evaluate the prognostic value of mALI in cancer cachexia. A receiver operator characteristic curve was used to compare the effectiveness of mALI and nutritional inflammatory indicators in predicting all-cause mortality in patients with cancer cachexia.
A total of 2438 patients with cancer cachexia were enrolled, including 1431 males and 1007 females. The sex-specific optimal cut-off values of mALI for males and females were 7.12 and 6.52, respectively. There was a non-linear relationship between mALI and all-cause mortality in patients with cancer cachexia. Low mALI was significantly associated with poor nutritional status, high tumour burden, and high inflammation. Patients with low mALI had significantly lower overall survival (OS) than those with high mALI (39.5% vs. 65.5%, P < 0.001). In the male population, OS was significantly lower in the low mALI group than in the high group (34.3% vs. 59.2%, P < 0.001). Similar results were also observed in the female population (46.3% vs. 75.0%, P < 0.001). mALI was an independent prognostic factor for patients with cancer cachexia (hazard ratio [HR] = 0.974, 95% confidence interval [CI] = 0.959-0.990, P = 0.001). For every standard deviation [SD] increase in mALI, the risk of poor prognosis for patients with cancer cachexia was reduced by 2.9% (HR = 0.971, 95%CI = 0.943-0.964, P < 0.001) in males and 8.9% (HR = 0.911, 95%CI = 0.893-0.930, P < 0.001) in females. mALI is an effective complement to the traditional Tumour, Lymph Nodes, Metastasis (TNM) staging system for prognosis evaluation and a promising nutritional inflammatory indicator with a better prognostic effect than the most commonly used clinical nutritional inflammatory indicators.
Low mALI is associated with poor survival in both male and female patients with cancer cachexia and is a practical and valuable prognostic assessment tool.
体成分和全身炎症的变化是癌症恶病质的重要特征。本多中心回顾性研究旨在探讨癌症恶病质患者体成分和全身炎症联合的预后价值。
改良晚期肺癌炎症指数（mALI），结合体成分和全身炎症，定义为四肢骨骼肌指数（ASMI）×血清白蛋白/中性粒细胞-淋巴细胞比值。ASMI 根据先前验证的人体测量方程进行估计。限制性立方样条用于评估 mALI 与癌症恶病质患者全因死亡率之间的关系。Kaplan-Meier 分析和 Cox 比例风险回归分析用于评估 mALI 在癌症恶病质中的预后价值。受试者工作特征曲线用于比较 mALI 和营养炎症指标在预测癌症恶病质患者全因死亡率方面的有效性。
共纳入 2438 例癌症恶病质患者，其中男 1431 例，女 1007 例。男性和女性 mALI 的最佳截断值分别为 7.12 和 6.52。癌症恶病质患者 mALI 与全因死亡率之间存在非线性关系。低 mALI 与营养状况差、肿瘤负荷高和炎症程度高显著相关。低 mALI 患者的总生存期（OS）明显低于高 mALI 患者（39.5%比 65.5%，P<0.001）。在男性人群中，低 mALI 组的 OS 明显低于高 mALI 组（34.3%比 59.2%，P<0.001）。在女性人群中也观察到类似的结果（46.3%比 75.0%，P<0.001）。mALI 是癌症恶病质患者的独立预后因素（风险比[HR] = 0.974，95%置信区间[CI] = 0.959-0.990，P=0.001）。mALI 每增加一个标准差[SD]，男性癌症恶病质患者预后不良的风险降低 2.9%（HR=0.971，95%CI=0.943-0.964，P<0.001），女性降低 8.9%（HR=0.911，95%CI=0.893-0.930，P<0.001）。mALI 是传统肿瘤、淋巴结、转移（TNM）分期系统进行预后评估的有效补充，也是一种有前途的营养炎症指标，其预后效果优于最常用的临床营养炎症指标。
低 mALI 与男性和女性癌症恶病质患者的生存不良相关，是一种实用且有价值的预后评估工具。
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