ArticleFrontiers in oncology2026
Prognostic significance and model evaluation of the modified advanced lung cancer inflammation index in locally advanced resectable gastric cancer patients with neoadjuvant chemotherapy.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sarcopenia is closely associated with poor outcomes in cancer patients. However, its prognostic significance in advanced gastric cancer (GC) patients undergoing neoadjuvant chemotherapy (NAC) remains unclear. This study investigated the prognostic value of the modified Advanced Lung Cancer Inflammation Index (mALI) in this population. Methods: We retrospectively included 209 patients with locally advanced resectable GC undergoing NAC followed by curative-intent surgery. Preoperative mALI after NAC was assessed using X-tile-derived cutoffs and sex-specific quartiles. OS was analyzed using Cox regression and Bayesian sensitivity analyses, and a postoperative nomogram was internally evaluated using C-index, calibration, DCA, and bootstrap resampling. Results: Patients were divided into high-mALI group and low-mALI group according to the mALI values, with cut-off values of 10.5 for males and 12.3 for females. Among 209 patients, high mALI was independently associated with improved OS (HR=0.52, 95% CI: 0.30-0.89, P=0.017). Bayesian sensitivity analyses yielded consistent results, and quartile-based analysis showed a protective trend with higher mALI (P for trend = 0.033). The mALI-based nomogram showed acceptable internal performance, with an apparent C-index of 0.765, an optimism-corrected C-index of 0.750, generally acceptable calibration, and potential clinical usefulness on DCA. Adding mALI to a base model including chemotherapy regimen, ypT stage, and ypN stage improved model fit (likelihood ratio test, P=0.012). Conclusions: Preoperative mALI after NAC was associated with OS in patients with locally advanced resectable GC undergoing NAC followed by surgery. The mALI-based nomogram may provide supplementary postoperative prognostic information but requires external validation before clinical implementation.
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