The Advanced Lung Cancer Inflammation Index Is Not Independently Prognostic for Overall Survival in De Novo Metastatic Pancreatic Cancer: A Comparison with Established Inflammation- and Nutrition-based Scores.

PURPOSE: The Advanced Lung Cancer Inflammation Index (ALI) combines body mass index, serum albumin, and the neutrophil-to-lymphocyte ratio, but overlaps with many other prognostic scores in pancreatic ductal adenocarcinoma (PDAC). We evaluated whether ALI is independently prognostic in de novo metastatic PDAC and whether it adds information beyond performance status and established scores. METHODS: In this single-centre retrospective cohort of patients with de novo metastatic PDAC diagnosed between 2019 and 2023, ALI was calculated at diagnosis. It was compared head-to-head with NLR, PNI, mGPS, CONUT, SII, PLR, LMR, and HALP using Harrell's concordance index (C-index), and its incremental value over a clinical model (ECOG performance status, CA 19 - 9, liver metastasis, age) was quantified with bootstrap internal validation. RESULTS: Of 102 patients, 101 were analysable (47 deaths; median follow-up 14.3 months). Low ALI (≤ 26.4) was associated with shorter median overall survival than high ALI (10.6 vs. 21.8 months; hazard ratio 1.97; p = 0.025), but this was not independent after multivariable adjustment for performance status (adjusted hazard ratio 1.62, 95% CI 0.85-3.09; p = 0.144). Discrimination was modest (C-index 0.591) and did not exceed that of mGPS (0.630), LMR (0.608), or NLR (0.596); adding ALI to the clinical model did not improve discrimination (ΔC-index - 0.001). A worst-case analysis for loss to follow-up was the only specification in which ALI remained independent. CONCLUSION: In de novo metastatic PDAC, ALI is not independently prognostic after adjustment for performance status and offers no discriminative advantage over simpler, established inflammation-based scores.