Association of advanced lung cancer inflammation index with the prevalence and all-cause mortality in patients with lung cancer

The advanced lung cancer inflammation index (ALI) has been proposed as a potential prognostic biomarker in lung cancer. However, evidence linking ALI to the prevalence of lung cancer and all-cause mortality remains limited. This study aimed to investigate the association between ALI and both the risk of lung cancer and all-cause mortality among individuals diagnosed with the disease. Data were obtained from 38,213 adults aged ≥ 20 years who participated in the 1999 to 2018 National Health and Nutrition Examination Survey. Cross-sectional analyses were performed to evaluate the association between ALI and lung cancer prevalence, while longitudinal analyses assessed the relationship between ALI and all-cause mortality among lung cancer patients. Multivariable logistic regression and Cox proportional hazards models were used, adjusting for relevant covariates. Multiple imputation was applied in sensitivity analyses to address missing data. Higher ALI levels were significantly associated with a lower risk of lung cancer. In the fully adjusted model, participants in the highest ALI quartile (Q4) had a 58% reduced risk compared to those in the lowest quartile (Q1) (OR = 0.42, 95% CI: 0.20–0.87, P = .019). Additionally, elevated ALI was linked to reduced all-cause mortality among individuals diagnosed with lung cancer. ALI may help stratify lung cancer risk in the general population and may be associated with overall survival outcomes among patients with the disease. Incorporating ALI into clinical risk assessments may aid in the development of more personalized treatment strategies. Prospective studies are needed to validate these findings and elucidate their underlying mechanisms.