{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:20:09Z","timestamp":1787746809567,"version":"build-2784847793"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2009600"],"award-info":[{"award-number":["2022YFC2009600"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2009601"],"award-info":[{"award-number":["2022YFC2009601"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82404061"],"award-info":[{"award-number":["82404061"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic inflammation is associated with cancer prognosis, but commonly used inflammatory indices show limited discrimination across heterogeneous malignancies. We developed and validated a novel inflammatory burden index, ALNCR, and tested whether integrating ALNCR with TNM stage improves overall survival (OS) prediction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analysed 6374 adults with cancer from the multicentre INSCOC cohort (2013\u20132021), randomly split into a training cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094464) and internal validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091910), and an external validation cohort from Fujian Cancer Hospital (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009759). Female proportions were 39.0%, 41.2% and 32.0%, and median ages were 60, 60 and 58\u2009years, respectively; Stage IV disease accounted for 45.4%, 45.8% and 64.8%. ALNCR was defined as (albumin\u2009\u00d7\u2009lymphocyte)\u2009\/\u2009(neutrophil\u2009\u00d7\u2009C\u2010reactive protein). Discrimination was assessed using C\u2010index and time\u2010dependent AUC, with comparisons to NLR, PLR, CAR, SII and PNI. A combined model (ALNCR.TNM) used ALNCR (cutoff 3.21) and TNM stage (I\/II vs. III\/IV); incremental value was quantified by net reclassification improvement (NRI) and integrated discrimination improvement (IDI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ALNCR showed the highest discrimination for OS among evaluated indices (C\u2010index 0.645 [95% CI 0.631\u20130.658] in training; 0.666 [0.645\u20130.686] in internal validation; and 0.657 [0.624\u20130.690] in external validation). High ALNCR (\u2265\u20093.21) was associated with longer OS than low ALNCR (median OS not reached vs. 22.3\u2009months; log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). After multivariable adjustment, high ALNCR remained associated with lower mortality (HR 0.56 [0.51\u20130.61], 0.50 [0.43\u20130.58] and 0.53 [0.42\u20130.67] across the three cohorts; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Adding ALNCR to TNM improved prediction over TNM alone (\u0394C\u2010index +0.021; NRI 0.067,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010; IDI 0.004,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and stratified patients into four risk groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), with consistent associations across major cancer types and clinical strata.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ALNCR is a simple inflammation\u2010based prognostic index that outperforms conventional inflammatory markers for OS prediction. Integrating ALNCR with TNM stage improves risk stratification and prognostic accuracy, supporting clinical implementation via a nomogram and web\u2010based calculator.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70339","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:22:54Z","timestamp":1787120574000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["ALNCR.TNM as a Novel Prognostic Tool for Cancer Survival"],"prefix":"10.1002","volume":"17","author":[{"given":"Heyang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases Capital Medical University  Beijing China"},{"name":"Department of Gastrointestinal Surgery\/Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University  Beijing China"},{"name":"Key Laboratory of Cancer FSMP for State Market Regulation  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guotian","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery\/Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University  Beijing China"},{"name":"Key Laboratory of Cancer FSMP for State Market Regulation  Beijing China"},{"name":"Department of General Surgery, Beijing Friendship Hospital, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelin","family":"Chai","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Virology, College of Life Sciences Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology Affiliated Dazu's Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyu","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases Capital Medical University  Beijing China"},{"name":"Department of Gastrointestinal Surgery\/Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University  Beijing China"},{"name":"Key Laboratory of Cancer FSMP for State Market Regulation  Beijing 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for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengtao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4514-8693","authenticated-orcid":false,"given":"Hanping","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery\/Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University  Beijing China"},{"name":"Key Laboratory of Cancer FSMP for State Market Regulation  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