Key Takeaways & Executive Findings
- •• The inflammatory burden index (IBI), calculated as CRP × albumin, is an independent prognostic factor for overall survival in non-small cell lung cancer. • High IBI is significantly associated with advanced tumor stage, lymph node metastasis, and poor differentiation. • A nomogram incorporating IBI and other clinicopathological factors accurately predicts 1-, 3-, and 5-year overall survival with good discrimination and calibration. • The nomogram provides a net clinical benefit in decision curve analysis, supporting its utility in clinical practice.
Abstract
Background: The inflammatory burden index (IBI), derived from C-reactive protein (CRP) and albumin, has emerged as a prognostic biomarker in various cancers. However, its role in non-small cell lung cancer (NSCLC) remains unclear. Methods: We retrospectively analyzed 1,024 NSCLC patients who underwent surgical resection between January 2013 and December 2018. The IBI was calculated as CRP × albumin. Optimal cutoff values were determined by X-tile software. Patients were divided into high and low IBI groups. Univariate and multivariate Cox regression analyses identified independent prognostic factors. A nomogram incorporating IBI and other clinicopathological variables was constructed and validated internally and externally. Model performance was assessed by concordance index (C-index), calibration curves, and decision curve analysis (DCA). Results: The optimal cutoff for IBI was 0.36. High IBI was significantly associated with advanced tumor stage, lymph node metastasis, and poor differentiation. Multivariate analysis revealed that IBI, tumor stage, and lymph node metastasis were independent prognostic factors for overall survival (OS). The nomogram achieved a C-index of 0.72 (95% CI: 0.68-0.76) in the training cohort and 0.70 (95% CI: 0.65-0.75) in the validation cohort. Calibration curves showed good agreement between predicted and observed OS. DCA demonstrated that the nomogram provided a net clinical benefit. Conclusions: The IBI is an independent prognostic factor for OS in NSCLC patients. The nomogram incorporating IBI can accurately predict individual survival and assist clinicians in risk stratification and treatment decision-making.
1. Introduction
Lung cancer remains the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of all cases. Despite advances in surgical techniques and systemic therapies, the prognosis of NSCLC patients remains poor, with a 5-year survival rate of only 15-20% for advanced stages. Accurate prognostic assessment is crucial for individualized treatment planning and patient counseling. Traditional prognostic factors, such as TNM stage and histologic grade, are insufficient to capture the heterogeneity of clinical outcomes. Therefore, there is an urgent need to identify novel biomarkers that can refine prognostic prediction.
In recent years, systemic inflammatory response has been recognized as a hallmark of cancer. Inflammatory biomarkers, such as C-reactive protein (CRP) and albumin, have been shown to correlate with prognosis in various malignancies. The inflammatory burden index (IBI), defined as CRP × albumin, integrates both inflammatory and nutritional status and has been proposed as a more comprehensive prognostic indicator. However, its prognostic value in NSCLC has not been fully investigated. In this study, we aimed to evaluate the prognostic significance of IBI in NSCLC patients and to develop a nomogram incorporating IBI and other clinicopathological variables to predict overall survival.
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ZHANG Wei, LI Ming, WANG Fang, CHEN Jing, LIU Yang, ZHAO Lei, SUN Hong, ZHOU Qiang, WU Jun, XU Yan (2025). Establishment and Validation of a Prognostic Nomogram for Predicting Overall Survival in Patients with Non-Small Cell Lung Cancer Based on the Inflammatory Burden Index. Chinese Journal of New Drugs. https://doi.org/cast_zgxyzz_1236731781714596256
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Frequently Asked Questions
What is the inflammatory burden index (IBI) and how is it calculated?
The inflammatory burden index (IBI) is a prognostic biomarker calculated by multiplying C-reactive protein (CRP) levels by albumin levels (IBI = CRP × albumin). It reflects both systemic inflammation and nutritional status, and higher values indicate a worse prognosis.
Why is the inflammatory burden index important in non-small cell lung cancer?
The IBI has been shown to be an independent prognostic factor for overall survival in NSCLC. It helps identify patients at higher risk of poor outcomes, allowing for more personalized treatment strategies and closer follow-up.
How was the nomogram developed and validated in this study?
The nomogram was developed using a training cohort of 1,024 NSCLC patients and validated internally and externally. It incorporated IBI, tumor stage, and lymph node metastasis. Model performance was assessed using concordance index, calibration curves, and decision curve analysis, demonstrating good discrimination and clinical utility.
What are the clinical implications of this nomogram?
The nomogram provides an individualized prediction of 1-, 3-, and 5-year overall survival for NSCLC patients. It can assist clinicians in risk stratification, guiding decisions on adjuvant therapy and follow-up intensity, ultimately improving patient management.
Can the nomogram be used in routine clinical practice?
Yes, the nomogram is user-friendly and based on readily available clinical and laboratory data. It has been validated to provide net clinical benefit, making it a practical tool for prognostic assessment in NSCLC patients.
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