Predictive efficacy of the advanced lung cancer inflammation index among patients with intrahepatic cholangiocarcinoma

Background: The advanced lung cancer inflammation index (ALI), which combines nutritional and inflammatory indicators, was recently identified as a promising prognostic biomarker. This study evaluates the predictive efficacy of ALI in patients undergoing curative-intent surgery for intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent curative-intent surgery for ICC were identified from a large multi-institutional database. Patients were categorized into "low ALI" and "high ALI" groups, and propensity score matching (PSM) was used to minimize intergroup differences. A time-dependent receiver operating characteristic curve (time-dependent ROC) and C-index were calculated to compare the prognostic performance of ALI with other biomarkers. Multivariate Cox regression analysis was conducted to identify independent predictors associated with overall survival (OS). Based on these predictors, a dynamic nomogram was developed to predict OS in ICC patients, and its performance was evaluated using an internal validation dataset. Results: Among 691 patients, 194 (28.08%) were categorized as having low ALI (≤ 27.6. Patients with low ALI had a worse 5-year OS rate (20.2% vs. 45.7%, p < 0.001), and this difference remained significant after PSM (20.2% vs. 42.3%, p < 0.001). Multivariate analysis identified low ALI as an independent predictor of increased mortality both before (hazard ratio [HR] 1.54, 95% CI: 1.25 - 1.90, p < 0.001) and after PSM (HR 1.59, 95% CI: 1.24 - 2.04, p < 0.001). The time-dependent AUC and C-index analyses indicated that ALI (C-index: 0.603) had the best predictive ability for OS in patients with ICC. The dynamic nomogram based on ALI demonstrated excellent predictive accuracy, validated through calibration curves, time-dependent ROC curves, and decision curve analysis. Conclusion: ALI is an independent predictor of OS among patients undergoing curative-intent surgery for ICC. The prognostic ability of the ALI is superior to the other nutrition- /inflammation-related biomarkers. ALI should be incorporated into predictive models to enhance prognostic stratification.