Research ArticleClinical Studies
Open Access

Modified Advanced Lung Cancer Inflammation Index Is an Independent Prognostic Factor for Gastric Cancer Patients Who Receive Curative Treatment

TORU AOYAMA, ITARU HASHIMOTO, YUKIO MAEZAWA, RYUKI ESASHI, SOSUKE YAMAMOTO, KIYOKO SHIMADA, KEISUKE KAZAMA, AYAKO TAMAGAWA, MIE TANABE, KEISUKE KOMORI, NATSUMI KAMIYA, NAOKO OKUDA, KOJI NUMATA, MAMORU UCHIYAMA, AYA SAITO and NORIO YUKAWA
In Vivo May 2025, 39 (3) 1524-1532; DOI: https://doi.org/10.21873/invivo.13952

Abstract

Background/Aim: Body composition changes and nutritional status affect the oncological outcomes in various malignancies. Modified advanced lung cancer inflammation index (mALI) evaluates both body composition changes and nutritional status. Herein, we aimed to examine the potential of mALI as a biomarker for gastric cancer (GC).

Patients and Methods: The medical records of 327 consecutive patients with gastric cancer who underwent curative resection at Yokohama City University from 2015 to 2022 were retrospectively reviewed. mALI was defined follows: Appendicular skeletal muscle index×Serum albumin/Neutrophil-to-lymphocyte ratio. The clinical impact of the mALI on the short- and long-term oncological outcomes was evaluated using Kaplan-Meier curves and Cox’s proportional hazards models.

Results: The 327 patients were classified into the mALI-low (n=121) and mALI-high (n=206) groups, respectively. The 1-, 3-, and 5-year overall survival (OS) rates were 94.0%, 71.4%, and 59.2%, respectively, in the mALI-low group, and 95.5%, 85.0%, and 79.9%, in the mALI-high group. In the multivariable analysis for OS, the mALI was identified as an independent prognostic factor [hazard ratio (HR)=1.794; 95% confidence interval (CI)=1.155-2.786, p=0.009]. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 79.6%, 66.0%, and 54.3%, respectively, in the mALI-low group, and 90.7%, 79.1%, and 75.5% in the mALI-high group. The multivariable analysis of RFS, identified the mALI as an independent prognostic factor (HR=1.654; 95% CI=1.105-2.477, p=0.015). In addition, the mALI status affected short-term oncological outcomes, including the occurrence of postoperative surgical complications and the introduction of postoperative adjuvant chemotherapy.

Conclusion: The mALI was an independent prognostic factor for OS and RFS in patients with GC. Our results suggest that the mALI is a promising biomarker for GC and a useful tool for the treatment and management of GC.

Keywords:

Introduction

Gastric cancer (GC) is the fourth most common cancer and second leading cause of cancer-related death worldwide (1, 2). Gastrectomy with D2 lymphadenectomy and perioperative adjuvant treatment is the global standard for locally advanced GC (3-5). Although the survival of patients with locally advanced GC after curative treatment is gradually improving, more than half of the patients with locally advanced GC experience recurrence, and survival after recurrence is limited (6, 7).

Various prognostic and predictive factors have been identified and reported to optimize GC treatment. Recently, the perioperative nutritional status and inflammation markers, such as the Glasgow Prognostic Score, neutrophil-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio, have been identified as promising biomarkers in various malignancies, including GC (8-11). Moreover, perioperative body composition changes, such as body weight loss, skeletal muscle loss, and adipose tissue loss, have also been reported as significant prognostic and predictive factors for gastrointestinal malignancies (12-15). Nevertheless, only a few biomarkers exist that can simultaneously evaluate both nutritional/inflammatory status and perioperative changes in body composition. Measurement of body composition changes is expensive and involves radiation exposure (using computed tomography, dual-energy X-ray absorptiometry, and other imaging modalities). Recently, to address cost and radiation exposure, Wen et al. developed a noninvasive and efficient anthropometric equation for calculating appendicular skeletal muscle mass (ASM) using data from the Chinese population (16). Moreover, a modified advanced lung cancer inflammation index (mALI), which combines body composition and systemic inflammation/nutrition, has been developed and reported as a significant prognostic factor in various malignancies (17, 18).

We hypothesized that the mALI would be a useful and promising biomarker in patients with GC. The body composition of patients with GC changes dramatically during the perioperative period (12). To investigate our hypothesis, we retrospectively evaluated the clinical impact of the mALI on both the short- and long-term oncological outcomes in patients with resectable GC who received curative treatment.

Patients and Methods

Patients. The medical records of a series of gastric cancer patients who underwent curative resection at Yokohama City University between 2015 and 2022 were retrospectively reviewed. All patients in the study had received a histological diagnosis of adenocarcinoma and had clinical stage I-III disease, as determined by the 15th edition of the general rules for gastric cancer published by the Japanese Gastric Cancer Association (19). They underwent curative gastrectomy as the primary treatment for their gastric cancer, with complete resection (R0) of the cancer along with radical lymph node dissection.

Surgical procedure and adjuvant treatment. All patients underwent gastrectomy with nodal dissection. For those with clinical stage IA disease, D1+ nodal dissection was performed, while patients with clinical stage ≥IB disease underwent D2 dissection. Additionally, patients diagnosed with pathological stage II or III disease were administered S-1-based adjuvant chemotherapy within six weeks postoperatively.

Measurement of body composition and mALI. The ASM was determined using the following formula:

Embedded Image

The mALI was defined as follows: ASMI×serum albumin/neutrophil-to-lymphocyte ratio (20, 21). All data were collected within one week before surgery.

Definition of postoperative complications (POCs). The Clavien-Dindo classification was used to define POCs. Grade 2 to 5 complications that developed either during the hospital stay or within 30 days post-surgery were retrospectively identified from patient records (22).

Follow-up. Follow-up was conducted at outpatient clinics. For the first 5 years, they received hematological tests, including measurements of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) tumor markers, and physical examinations at least every three months. Additionally, during the initial three years after surgery, they received computed tomography (CT) scans every 3 months. This frequency was then reduced to every 6 months until 5 years post-surgery.

Statistical analysis. All variables are presented as counts and percentages. The patients were divided in two groups, based on the mALI values. The cutoff values for the mALI were set at 10 for male patients and 12 for female patients, based on previous literature (17, 18). In this study, 121 patients were classified into the mALI-low group, while 206 were classified into the mALI-high group. The chi-square test was used to analyze differences in clinicopathological parameters between the two groups. Overall survival (OS) and recurrence-free survival (RFS) were estimated with the Kaplan-Meier method and compared using log-rank test. We conducted univariable and multivariable survival analyses using a Cox proportional hazards model. All p-values of <0.05 were considered to indicate statistical significance. All statistical analyses were performed using SPSS (v27.0 J Win; IBM, Armonk, NY, USA). This study received approval from the IRB of Yokohama City University (IRB number: F220500063).

Results

Patient background. This study included a total of 327 GC patients with a median age of 71 years (range=32-88). Among them, 226 patients were male, and 101 were female. The age distribution showed 144 patients under 70 years of age and 183 patients over 70 years of age. Pathological examinations revealed that 164 patients had T1 tumors, while 163 had ≥T2 tumors; 198 patients were negative for lymph node metastasis, and 129 were positive. The comparison of the backgrounds of the patients in the two groups revealed no significant differences in age, T status, lymph node metastasis status, or h-vascular invasion status, indicating that their clinical characteristics were comparable.

Survival analysis. The 1-, 3-, and 5-year OS rates were 94.0%, 71.4%, and 59.2% respectively for the mALI-low group, compared to 95.5%, 85.0%, and 79.9% for the mALI-high group (Figure 1, Table I). The differences between the two groups were statistically significant (log-rank test, all OS rates, p<0.001). Univariable analyses identified age, T status, lymph node metastasis, mALI, lymphatic invasion, vascular invasion, and postoperative surgical complications as prognostic factors for OS. The multivariable analysis confirmed the mALI as one of an independent prognostic factor [hazard ratio (HR)=1.794, 95% confidence interval (CI)=1.155-2.786, p=0.009] (Table II). Regarding recurrence-free survival (RFS), the 1-, 3-, and 5-year rates were 79.6%, 66.0%, and 54.3% for the mALI-low group, and 90.7%, 79.1%, and 75.5% for the mALI-high group (Figure 2). The differences between the two groups were statistically significant (all RFS rates, p<0.001). Univariable analyses identified age, T status, lymph node metastasis, mALI, lymphatic invasion, vascular invasion, and postoperative surgical complications as prognostic factors for RFS. The multivariable analysis confirmed the mALI as one of an independent prognostic factor for RFS (Cox proportional hazards model, HR=1.654, 95% CI=1.105-2.477, p=0.015) (Table III).

Figure 1.
Figure 1.

Overall survival of gastric cancer patients in the modified advanced lung cancer inflammation index (mALI)-high and mALI-low groups.

View this table:
Table I.

Comparison of survival rates stratified by patient characteristics.

View this table:
Table II.

Univariable and multivariable Cox proportional hazards regression analysis of clinicopathological factors for overall survival.

Figure 2.
Figure 2.

Recurrence-free survival of gastric cancer patients in the modified advanced lung cancer inflammation index (mALI)-high and mALI-low groups.

View this table:
Table III.

Univariable and multivariable Cox proportional hazards analysis of clinicopathological factors for recurrence-free survival.

Postoperative clinical course of the mALI-low and mALI-high groups. When comparing recurrence sites between the mALI-low and mALI-high groups, it was found that peritoneal recurrence was significantly more common in the mALI-low group (16.5% vs. 9.2%, p=0.049) (Table IV). However, the rates of hematological recurrence (11.6% vs. 7.8%, p=0.250) and lymph node recurrence (7.4% vs. 6.8%, p=0.827) in the two groups were similar.

View this table:
Table IV.

Patterns of recurrence according to hemoglobin.

Additionally, significant differences were observed in postoperative surgical complications and the course of postoperative adjuvant chemotherapy between the groups. The mALI-low group experienced significantly higher rates of postoperative surgical complications than the mALI-high group [47.9% (58/121) vs. 31.5% (65/205), p=0.003]. Furthermore, a higher percentage of patients in the mALI-low group required postoperative adjuvant chemotherapy relative to those in the mALI-high group [45.5% (55/121) vs. 34.5% (71/206), p=0.049]. Despite this, the proportion of patients who actually received postoperative adjuvant chemotherapy was significantly lower in the mALI-low group, compared to the mALI-high group [60.0% (33/55) vs. 80.3% (57/71), p=0.012].

Discussion

The aim of the present study was to evaluate the clinical impact of the mALI in patients with GC who received curative treatment. The major finding was that the mALI was an independent prognostic factor for patients with GC. In addition, the mALI affected the introduction of postoperative adjuvant chemotherapy. Our results suggest that the mALI is a promising biomarker for GC and a useful tool for the treatment and management of GC.

We found that the mALI is a prognostic factor for both OS and RFS. Similar results have been reported in lung and renal cell cancers. Sato et al. evaluated the clinical relationship between the mALI and oncological outcomes in 665 patients with non-small cell lung cancer who underwent curative resection (23). They divided 665 patients into a mALI-low group (n=168) and mALI-high group (n=497), using a cut-off value of 9.49 for males and 8.02 for females. The 5-year OS and RFS rates were significantly lower in the mALI-low group than in the mALI-high group. In addition, mALI was an independent prognostic factor for OS and RFS. In the postoperative clinical course, they suggested that the mALI status was associated with postoperative surgical complications. Moreover, Mao et al. clarified the prognostic impact of the mALI in 440 renal cell carcinoma patients who underwent curative resection (24). They divided 440 patients into mALI-low (n=224) and mALI-high (n=216) groups. The OS in the mALI-low group was significantly worse than in the mALI-high group and mALI status was an independent prognostic factor for OS. Considering the present and previous studies, the mALI has a clinical impact on oncological outcomes in various malignancies, including GC.

We aimed to discuss why the mALI status affects long-term oncological outcomes. There are several possible explanations for this finding. The most likely explanation is that the mALI status affects postoperative surgical complications. In the present study, the postoperative surgical complication rate in the mALI-low group was significantly higher than that in the m-ALI-high group. Similar results were observed in a previous study. Sato et al. reported that the frequency of postoperative complications was significantly lower in mALI group than in the low-mALI group (p=0.010) (23). Recent studies have shown that postoperative surgical complications are associated with long-term oncological outcomes in gastric cancer (25). Consequently, the mALI status impacts postoperative surgical complications, leading to a poor prognosis.

The mALI status influences the effectiveness of postoperative adjuvant chemotherapy. In the present study, a significantly higher number of patients in the mALI-low group required adjuvant chemotherapy compared to the mALI-high group. However, the initiation of postoperative adjuvant chemotherapy was significantly lower in the mALI-low group than in the mALI-high group. Pivotal phase III studies have shown that perioperative adjuvant chemotherapy improves the survival of patients with locally advanced gastric cancer (GC) (26, 27). These findings suggest that while patients in the mALI-low group had a greater need for postoperative adjunctive therapy, fewer actually received it, potentially missing the benefits of adjuvant chemotherapy. Therefore, the mALI status impacts the administration of postoperative adjuvant chemotherapy, leading to a poorer prognosis.

The present study was associated with some limitations. Firstly, it was a retrospective study conducted at a single institution, which may introduce selection and time biases. Secondly, the optimal cutoff value for the mALI remains unclear. In this study, the cutoff value for the mALI was based on 3- and 5-year OS rates from previous research. However, the cutoff value of the mALI is affected by the type of malignancy, number of patients, tumor stage, and type of treatment. Moreover, the optimal cutoff value for the mALI also depends on the detection method (21, 23). Therefore, further studies are necessary to clarify and establish optimal methods and cutoff values for the mALI. The findings of this study should be validated in a larger cohort.

In conclusion, the mALI is an independent prognostic factor for patients with GC who underwent curative resection. In addition, the mALI affects the introduction of postoperative adjuvant chemotherapy. Our results suggest that the mALI is a promising biomarker for GC and a useful tool for the treatment and management of GC.

Footnotes

  • Authors’ Contributions

    IH and TA contributed substantially to this concept and design. TA, IH, NO, NK, Komori Keisuke (KK1), YM, RE, SY, MU, Kazama Keisuke (KK2), and NY made substantial contributions to data acquisition, analysis, and interpretation. TA, KS, AS, MT, AT, and YR were involved in drafting and critically revising the manuscript for important intellectual content. TA and IH approved the final version of the manuscript.

  • Conflicts of Interest

    The Authors declare no conflicts of interest in association with the present study.

  • Received January 3, 2025.
  • Revision received February 4, 2025.
  • Accepted February 17, 2025.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (https://creativecommons.org/licenses/by-nc-nd/4.0).

References

  1. ↵
    1. Bray F,
    2. Ferlay J,
    3. Soerjomataram I,
    4. Siegel RL,
    5. Torre LA,
    6. Jemal A
    : Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6): 394-424, 2018. DOI: 10.3322/caac.21492
    OpenUrlCrossRefPubMed
  2. ↵
    1. Bray F,
    2. Laversanne M,
    3. Sung H,
    4. Ferlay J,
    5. Siegel RL,
    6. Soerjomataram I,
    7. Jemal A
    : Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3): 229-263, 2024. DOI: 10.3322/caac.21834
    OpenUrlCrossRef
  3. ↵
    1. Japanese Gastric Cancer Association
    : Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 26(1): 1-25, 2023. DOI: 10.1007/s10120-022-01331-8
    OpenUrlCrossRefPubMed
    1. Lordick F,
    2. Carneiro F,
    3. Cascinu S,
    4. Fleitas T,
    5. Haustermans K,
    6. Piessen G,
    7. Vogel A,
    8. Smyth EC, ESMO Guidelines Committee
    : Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 33(10): 1005-1020, 2022. DOI: 10.1016/j.annonc.2022.07.004
    OpenUrlCrossRefPubMed
  5. ↵
    1. Ajani JA,
    2. D’Amico TA,
    3. Bentrem DJ,
    4. Chao J,
    5. Cooke D,
    6. Corvera C,
    7. Das P,
    8. Enzinger PC,
    9. Enzler T,
    10. Fanta P,
    11. Farjah F,
    12. Gerdes H,
    13. Gibson MK,
    14. Hochwald S,
    15. Hofstetter WL,
    16. Ilson DH,
    17. Keswani RN,
    18. Kim S,
    19. Kleinberg LR,
    20. Klempner SJ,
    21. Lacy J,
    22. Ly QP,
    23. Matkowskyj KA,
    24. McNamara M,
    25. Mulcahy MF,
    26. Outlaw D,
    27. Park H,
    28. Perry KA,
    29. Pimiento J,
    30. Poultsides GA,
    31. Reznik S,
    32. Roses RE,
    33. Strong VE,
    34. Su S,
    35. Wang HL,
    36. Wiesner G,
    37. Willett CG,
    38. Yakoub D,
    39. Yoon H,
    40. McMillian N,
    41. Pluchino LA
    : Gastric cancer, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 20(2): 167-192, 2022. DOI: 10.6004/jnccn.2022.0008
    OpenUrlCrossRefPubMed
  6. ↵
    1. Janjigian YY,
    2. Shitara K,
    3. Moehler M,
    4. Garrido M,
    5. Salman P,
    6. Shen L,
    7. Wyrwicz L,
    8. Yamaguchi K,
    9. Skoczylas T,
    10. Campos Bragagnoli A,
    11. Liu T,
    12. Schenker M,
    13. Yanez P,
    14. Tehfe M,
    15. Kowalyszyn R,
    16. Karamouzis MV,
    17. Bruges R,
    18. Zander T,
    19. Pazo-Cid R,
    20. Hitre E,
    21. Feeney K,
    22. Cleary JM,
    23. Poulart V,
    24. Cullen D,
    25. Lei M,
    26. Xiao H,
    27. Kondo K,
    28. Li M,
    29. Ajani JA
    : First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet 398(10294): 27-40, 2021. DOI: 10.1016/S0140-6736(21)00797-2
    OpenUrlCrossRefPubMed
  7. ↵
    1. Janjigian YY,
    2. Ajani JA,
    3. Moehler M,
    4. Shen L,
    5. Garrido M,
    6. Gallardo C,
    7. Wyrwicz L,
    8. Yamaguchi K,
    9. Cleary JM,
    10. Elimova E,
    11. Karamouzis M,
    12. Bruges R,
    13. Skoczylas T,
    14. Bragagnoli A,
    15. Liu T,
    16. Tehfe M,
    17. Zander T,
    18. Kowalyszyn R,
    19. Pazo-Cid R,
    20. Schenker M,
    21. Feeny K,
    22. Wang R,
    23. Lei M,
    24. Chen C,
    25. Nathani R,
    26. Shitara K
    : First-line nivolumab plus chemotherapy for advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma: 3-year follow-up of the phase III CheckMate 649 trial. J Clin Oncol 42(17): 2012-2020, 2024. DOI: 10.1200/JCO.23.01601
    OpenUrlCrossRef
  8. ↵
    1. Aoyama T,
    2. Kazama K,
    3. Maezawa Y,
    4. Hara K
    : Usefulness of nutrition and inflammation assessment tools in esophageal cancer treatment. In Vivo 37(1): 22-35, 2023. DOI: 10.21873/invivo.13051
    OpenUrlAbstract/FREE Full Text
    1. Aoyama T,
    2. Yukawa N,
    3. Saito A
    : Clinical impact of nutrition and inflammation assessment tools in colorectal cancer treatment. Anticancer Res 44(4): 1335-1351, 2024. DOI: 10.21873/anticanres.16930
    OpenUrlAbstract/FREE Full Text
    1. Aoyama T,
    2. Hara K,
    3. Kazama K,
    4. Maezawa Y
    : Clinical impact of nutrition and inflammation assessment tools in gastric cancer treatment. Anticancer Res 42(11): 5167-5180, 2022. DOI: 10.21873/anticanres.16023
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Aoyama T,
    2. Maezawa Y,
    3. Hashimoto I,
    4. Rino Y,
    5. Oshima T
    : Clinical impact of nutrition and inflammation assessment tools in pancreatic cancer treatment. Anticancer Res 43(9): 3849-3860, 2023. DOI: 10.21873/anticanres.16572
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Aoyama T
    : Perioperative body composition changes in the multimodal treatment of gastrointestinal cancer. Surg Today 50(3): 217-222, 2020. DOI: 10.1007/s00595-019-01815-8
    OpenUrlCrossRefPubMed
    1. Aoyama T,
    2. Yoshikawa T,
    3. Shirai J,
    4. Hayashi T,
    5. Yamada T,
    6. Tsuchida K,
    7. Hasegawa S,
    8. Cho H,
    9. Yukawa N,
    10. Oshima T,
    11. Rino Y,
    12. Masuda M,
    13. Tsuburaya A
    : Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol 20(6): 2000-2006, 2013. DOI: 10.1245/s10434-012-2776-6
    OpenUrlCrossRefPubMed
    1. Aoyama T,
    2. Sato T,
    3. Maezawa Y,
    4. Kano K,
    5. Hayashi T,
    6. Yamada T,
    7. Yukawa N,
    8. Oshima T,
    9. Rino Y,
    10. Masuda M,
    11. Ogata T,
    12. Cho H,
    13. Yoshikawa T
    : Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer. Int J Clin Oncol 22(3): 476-483, 2017. DOI: 10.1007/s10147-017-1089-y
    OpenUrlCrossRefPubMed
  15. ↵
    1. Aoyama T,
    2. Kawabe T,
    3. Fujikawa H,
    4. Hayashi T,
    5. Yamada T,
    6. Tsuchida K,
    7. Yukawa N,
    8. Oshima T,
    9. Rino Y,
    10. Masuda M,
    11. Ogata T,
    12. Cho H,
    13. Yoshikawa T
    : Loss of lean body mass as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol 22(8): 2560-2566, 2015. DOI: 10.1245/s10434-014-4296-z
    OpenUrlCrossRefPubMed
  16. ↵
    1. Wen X,
    2. Wang M,
    3. Jiang CM,
    4. Zhang YM
    : Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults. Asia Pac J Clin Nutr 20(4): 551-556, 2011.
    OpenUrlPubMed
  17. ↵
    1. Yang M,
    2. Hu X,
    3. Wang H,
    4. Zhang L,
    5. Hao Q,
    6. Dong B
    : Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study. J Cachexia Sarcopenia Muscle 8(2): 251-258, 2017. DOI: 10.1002/jcsm.12163
    OpenUrlCrossRefPubMed
  18. ↵
    1. Hu X,
    2. Zhang L,
    3. Wang H,
    4. Hao Q,
    5. Dong B,
    6. Yang M
    : Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Sci Rep 7(1): 3171, 2017. DOI: 10.1038/s41598-017-03388-3
    OpenUrlCrossRefPubMed
  19. ↵
    1. Japanese Gastric Cancer Association
    : Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2): 101-112, 2011. DOI: 10.1007/s10120-011-0041-5
    OpenUrlCrossRefPubMed
  20. ↵
    1. Xie HL,
    2. Ruan GT,
    3. Wei L,
    4. Zhang Q,
    5. Ge YZ,
    6. Song MM,
    7. Zhang X,
    8. Lin SQ,
    9. Liu XY,
    10. Zhang XW,
    11. Li XR,
    12. Zhang KP,
    13. Hu CL,
    14. Yang M,
    15. Tang M,
    16. Song CH,
    17. Cong MH,
    18. Weng M,
    19. Li ZN,
    20. Li W,
    21. Wang KH,
    22. Shi HP
    : The prognostic value of the combination of body composition and systemic inflammation in patients with cancer cachexia. J Cachexia Sarcopenia Muscle 14(2): 879-890, 2023. DOI: 10.1002/jcsm.13205
    OpenUrlCrossRefPubMed
  21. ↵
    1. Kim EY,
    2. Kim N,
    3. Kim YS,
    4. Seo JY,
    5. Park I,
    6. Ahn HK,
    7. Jeong YM,
    8. Kim JH
    : Prognostic significance of modified advanced lung cancer inflammation index (ALI) in patients with small cell lung cancer_ comparison with original ALI. PLoS One 11(10): e0164056, 2016. DOI: 10.1371/journal.pone.0164056
    OpenUrlCrossRefPubMed
  22. ↵
    1. Clavien PA,
    2. Barkun J,
    3. de Oliveira ML,
    4. Vauthey JN,
    5. Dindo D,
    6. Schulick RD,
    7. de Santibañes E,
    8. Pekolj J,
    9. Slankamenac K,
    10. Bassi C,
    11. Graf R,
    12. Vonlanthen R,
    13. Padbury R,
    14. Cameron JL,
    15. Makuuchi M
    : The Clavien-Dindo classification of surgical complications. Ann Surg 250(2): 187-196, 2009. DOI: 10.1097/SLA.0b013e3181b13ca2
    OpenUrlCrossRefPubMed
  23. ↵
    1. Sato S,
    2. Sezaki R,
    3. Shinohara H
    : Significance of preoperative evaluation of modified advanced lung cancer inflammation index for patients with resectable non-small cell lung cancer. Gen Thorac Cardiovasc Surg 72(8): 527-534, 2024. DOI: 10.1007/s11748-023-02003-9
    OpenUrlCrossRefPubMed
  24. ↵
    1. Mao W,
    2. Wang K,
    3. Wu Y,
    4. Ni J,
    5. Zhang H,
    6. Wang Y,
    7. Wu Z,
    8. Liu R,
    9. Geng J,
    10. Chen S,
    11. Chen M
    : Prognostic significance of modified advanced lung cancer inflammation index in patients with renal cell carcinoma undergoing laparoscopic nephrectomy: a multi-institutional, propensity score matching cohort study. Front Nutr 8: 781647, 2022. DOI: 10.3389/fnut.2021.781647
    OpenUrlCrossRefPubMed
  25. ↵
    1. Hayashi T,
    2. Yoshikawa T,
    3. Aoyama T,
    4. Hasegawa S,
    5. Yamada T,
    6. Tsuchida K,
    7. Fujikawa H,
    8. Sato T,
    9. Ogata T,
    10. Cho H,
    11. Oshima T,
    12. Rino Y,
    13. Masuda M
    : Impact of infectious complications on gastric cancer recurrence. Gastric Cancer 18(2): 368-374, 2015. DOI: 10.1007/s10120-014-0361-3
    OpenUrlCrossRefPubMed
  26. ↵
    1. Sakuramoto S,
    2. Sasako M,
    3. Yamaguchi T,
    4. Kinoshita T,
    5. Fujii M,
    6. Nashimoto A,
    7. Furukawa H,
    8. Nakajima T,
    9. Ohashi Y,
    10. Imamura H,
    11. Higashino M,
    12. Yamamura Y,
    13. Kurita A,
    14. Arai K, ACTS-GC Group
    : Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18): 1810-1820, 2007. DOI: 10.1056/NEJMoa072252
    OpenUrlCrossRefPubMed
  27. ↵
    1. Yoshida K,
    2. Kodera Y,
    3. Kochi M,
    4. Ichikawa W,
    5. Kakeji Y,
    6. Sano T,
    7. Nagao N,
    8. Takahashi M,
    9. Takagane A,
    10. Watanabe T,
    11. Kaji M,
    12. Okitsu H,
    13. Nomura T,
    14. Matsui T,
    15. Yoshikawa T,
    16. Matsuyama J,
    17. Yamada M,
    18. Ito S,
    19. Takeuchi M,
    20. Fujii M
    : Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol 37(15): 1296-1304, 2019. DOI: 10.1200/JCO.18.01138
    OpenUrlCrossRefPubMed
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Modified Advanced Lung Cancer Inflammation Index Is an Independent Prognostic Factor for Gastric Cancer Patients Who Receive Curative Treatment
TORU AOYAMA, ITARU HASHIMOTO, YUKIO MAEZAWA, RYUKI ESASHI, SOSUKE YAMAMOTO, KIYOKO SHIMADA, KEISUKE KAZAMA, AYAKO TAMAGAWA, MIE TANABE, KEISUKE KOMORI, NATSUMI KAMIYA, NAOKO OKUDA, KOJI NUMATA, MAMORU UCHIYAMA, AYA SAITO, NORIO YUKAWA
In Vivo May 2025, 39 (3) 1524-1532; DOI: 10.21873/invivo.13952
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