Clinical implication of the advanced lung cancer inflammation index in patients with right-sided colon cancer after complete mesocolic excision: a propensity score-matched analysis

Abstract

Abstract Background This study aimed to assess the clinical implications of the advanced lung cancer inflammation index (ALI) in patients with right-sided colon cancer (RCC) after complete mesocolic excision (CME). Methods A total of 441 patients with RCC who underwent CME were included. The optimal cut-off value for the ALI was determined using the X-tile software. Logistic and Cox regression analyses were used to identify risk factors for postoperative complications and long-term outcomes. Predictive nomograms for overall survival (OS) and disease-free survival (DFS) were constructed after propensity score matching (PSM), and their performance was assessed using the net reclassification improvement index (NRI), integrated discrimination improvement index (IDI), and time-dependent receiver operating characteristic (time-ROC) curve analysis. Results The optimal preoperative ALI cut-off value was 36.3. After PSM, ASA classification 3/4, operative duration, and a low ALI were independently associated with postoperative complications in the multivariate analysis (all P<0.05). Cox regression analysis revealed that an age >60 years, a carbohydrate antigen 19-9 (CA19-9) level >37 U/mL, pathological N+ stage, and a low ALI were independently correlated with OS (all P<0.05). A CA19-9 level >37 U/mL, pathological N+ stage, lymphovascular invasion, and a low ALI were independent predictors of DFS (all P<0.05). Predictive nomograms for OS and DFS were constructed using PSM. Furthermore, a nomogram combined with the ALI was consistently superior to a non-ALI nomogram or the pathological tumor-node-metastasis classification based on the NRI, IDI, and time-ROC curve analysis after PSM (all P<0.05). Conclusion The ALI was an effective indicator for predicting short- and long-term outcomes in patients with RCC.