Şeber Erdoğan Selçuk, Elçiçek Ömer Faruk, Çavdar Eyyüp, Yalıcı Özge, Bilen Yıldız Garip, Karaduman İlker, Gedik Ezel, Avcı Okan
Department of Medical Oncology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdağ, Turkey.
Department of Medical Oncology, Training and Research Hospital, Adiyaman University, Adiyaman, Turkey.
Asia Pac J Clin Oncol. 2025 Jun 18:e14200. doi: 10.1111/ajco.14200.
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.
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.
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.
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.
本研究旨在探讨炎症指标，包括晚期肺炎症指数（ALI），在接受一线铂类-依托泊苷化疗的广泛期小细胞肺癌（ES-SCLC）患者中的预后意义。
该研究纳入了167例ES-SCLC患者。纳入确诊为ES-SCLC组织学且已完成至少2个月一线治疗（铂类-依托泊苷化疗方案且未接受免疫治疗）的患者。从电子记录系统中记录患者首次治疗前的人口统计学信息、临床病理特征和血液参数（首次化疗前第1天至第7天的血液检测结果）。
中位年龄为62岁（范围：40 - 88岁）。共有163例（97.6%）患者死于癌症相关原因。所有患者的中位总生存期（mOS）为9个月（95%置信区间：8 - 10个月）。在单因素分析中，性别、年龄、吸烟、体重指数、脑转移状态、骨转移状态、预防性颅脑照射（PCI）和上腔静脉综合征（SVCSS）与生存无关。较差的体能状态（p = 0.036）、低C反应蛋白-白蛋白-淋巴细胞指数（CALLY）（p = 0.030）、高全身免疫炎症指数（SII）（p = 0.042）和低离子指数（ALI）（p = 0.016）在单因素分析中提示生存较差。对单因素分析中发现的预后因素在多因素分析中进行评估。在建立的模型中，仅ALI（风险比[HR] = 0.68，95%置信区间：0.49 - 0.93，p = 0.016）被发现是总生存期的独立预后因素。根据CALLY、SII、ALI和东部肿瘤协作组（ECOG）体能状态的相应mOS分别为8个月对10个月（p = 0.020）、10个月对8个月（p = 0.030）、8个月对9个月（p = 0.010）和9个月对8个月（p = 0.025），差异有统计学意义。
CALLY、SII及ALI和ECOG体能状态可能是接受化疗的ES-SCLC患者临床医生有用的预后标志物，其中ALI是最强的预后因素。这些易于获取且易于计算的标志物可通过为临床医生提供宿主免疫与肿瘤相关炎症之间动态平衡的实时评估，促进具有成本效益的随访和治疗决策。
