Combination of Advanced Lung Cancer Inflammation Index and C-Reactive Protein Is a Prognostic Factor in Patients With Operable Non-Small Cell Lung Cancer

BACKGROUND: Previous study of ours showed that advanced lung cancer inflammation index (ALI) and C-reactive protein (CRP) are independent significant prognostic factors in operable non-small cell lung cancer (NSCLC) patients. Since both ALI and CRP are markers of inflammation, the aim of this study was to examine whether the combination of ALI and CRP is a prognostic indicator of resected NSCLC or not. METHODS: Three hundred forty-one NSCLC patients who underwent surgery at our institution between 2008 and 2012 were included. ALI score was calculated as BMI × ALB/NLR with BMI indicating body mass index, ALB indicating serum albumin and NLR indicating neutrophil lymphocyte ratio. The prognostic significance of the combination of ALI and CRP was evaluated. RESULTS: Compared to patients with high ALI (> 37.67) group, low ALI group had significantly poorer cancer-specific survival. Similarly, patients with high CRP (> 0.15 mg/dL) had poorer survival. Based on the combination of ALI and CRP, patients with high ALI and low CRP were assigned an ALI_CRP score of 0, those with both high or both low were assigned an ALI_CRP score of 1, and those with low ALI and high CRP were assigned an ALI_CRP score of 2. The patients’ cancer-specific survival was significantly related to this ALI_CRP score. On multivariate analysis, gender, histology, pN status, serum carcinoembryonic antigen (CEA) level and the ALI_CRP score were associated independently with cancer-specific survival. CONCLUSIONS: The combination of ALI and CRP is a useful predictor of overall survival and could be a simple prognostic tool to help identify operable NSCLC patients.