{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T02:59:05Z","timestamp":1785121145215,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Pseudomyxoma peritonei (PMP) prognosis remains heterogeneous. Systemic inflammation and nutrition are linked to cancer survival, but their role in PMP is unclear. We aimed to evaluate the prognostic impact of inflammation\u2013nutrition status in appendiceal high\u2010grade PMP and to develop and internally validate a perioperative prognostic model.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively included patients with pathologically confirmed appendiceal high\u2010grade PMP who underwent cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) between January 2015 and December 2024. Baseline variables included demographics, body mass index (BMI), tumor markers (CEA, CA19\u20109, CA125), inflammation\u2013nutrition indices (advanced lung cancer inflammation index [ALI], prognostic nutritional index [PNI], neutrophil\u2010to\u2010lymphocyte ratio [NLR], platelet\u2010to\u2010lymphocyte ratio [PLR], lymphocyte\u2010to\u2010monocyte ratio [LMR], systemic inflammation score [SIS], systemic immune\u2013inflammation index [SII]), prior surgical score (PSS), peritoneal cancer index (PCI), completeness of cytoreduction (CC), HIPEC, pathological subtype, and Ki\u201067. Overall survival (OS) was the primary endpoint. Prognostic factors were identified by univariable and multivariable Cox models, and a nomogram was developed and internally validated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 223 patients (146 females, 65.5%), median age was 59\u2009years, and median OS was 21\u2009months. In the multivariable Cox regression model, independent risk factors for worse overall survival (OS) were high\u2010grade with signet\u2010ring cells (hazard ratio [HR]\u2009=\u20092.575, 95% CI 1.749\u20133.790;\n p<\/jats:italic>\n \u2009<\u20090.001), elevated CA19\u20109 (HR\u2009=\u20092.189, 95% CI 1.501\u20133.192;\n p<\/jats:italic>\n \u2009<\u20090.001), elevated CA125 (HR\u2009=\u20091.495, 95% CI 1.050\u20132.127;\n p<\/jats:italic>\n \u2009=\u20090.026), high Ki\u201067 (HR\u2009=\u20091.976, 95% CI 1.238\u20133.154;\n p<\/jats:italic>\n \u2009=\u20090.004), and an unfavorable CC (CC1\u20133) (HR\u2009=\u20092.705, 95% CI 1.295\u20135.648;\n p<\/jats:italic>\n \u2009=\u20090.008), while receipt of hyperthermic intraperitoneal chemotherapy (HIPEC) (HR\u2009=\u20090.611, 95% CI 0.377\u20130.991;\n p<\/jats:italic>\n \u2009=\u20090.046) and a high ALI (HR\u2009=\u20090.576, 95% CI 0.398\u20130.834;\n p<\/jats:italic>\n \u2009=\u20090.003) were independent protective factors. The model achieved a C\u2010index of 0.753, with 1\u2010, 2\u2010, and 3\u2010year AUCs of 0.810, 0.839, and 0.775, respectively. Calibration error was low (\u22483%\u20136%) and decision\u2010curve analysis showed sustained net benefit across broad threshold ranges.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The ALI is an independent prognostic marker in appendiceal high\u2010grade PMP. A nomogram incorporating ALI with tumor and pathological variables enabled reliable perioperative survival prediction with strong discrimination, calibration, and clinical utility.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70884","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T02:00:24Z","timestamp":1785117624000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced Lung Cancer Inflammation Index as a Prognostic Inflammation\u2013Nutrition Marker in Appendiceal High\u2010Grade Pseudomyxoma Peritonei: A 10\u2010Year Single\u2010Center Study"],"prefix":"10.1111","author":[{"given":"Yun","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Oncology Beijing Chao\u2010Yang Hospital, Capital Medical University Beijing China"},{"name":"Department of General Practice Aerospace Center Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2083-2800","authenticated-orcid":false,"given":"Ruiqing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Myxoma Aerospace Center Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2898-3412","authenticated-orcid":false,"given":"Zhenhai","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of General Practice Aerospace Center Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Practice Aerospace Center Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyu","family":"An","sequence":"additional","affiliation":[{"name":"Department of Oncology Beijing Chao\u2010Yang Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ejso.2020.02.012","article-title":"Appendiceal Tumours and Pseudomyxoma Peritonei: Literature Review With PSOGI\/EURACAN Clinical Practice Guidelines for Diagnosis and Treatment","volume":"47","author":"Govaerts K.","year":"2021","journal-title":"European Journal of Surgical Oncology"},{"issue":"3","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2020.6363","article-title":"The Role of Hyperthermic Intraperitoneal Chemotherapy in Pseudomyxoma Peritonei After Cytoreductive Surgery","volume":"156","author":"Kusamura S.","year":"2021","journal-title":"JAMA Surgery"},{"issue":"2","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1245\/s10434-018-7007-3","article-title":"Outcomes in Peritoneal Dissemination From Signet Ring Cell Carcinoma of the Appendix Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy","volume":"26","author":"Munoz\u2010Zuluaga C.","year":"2019","journal-title":"Annals of Surgical Oncology"},{"issue":"8","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1002\/jso.26671","article-title":"Nomogram to Predict Overall Survival of Patients With Pseudomyxoma Peritonei of Appendiceal Origin: A Retrospective Cohort Study","volume":"124","author":"Bai M.","year":"2021","journal-title":"Journal of Surgical Oncology"},{"issue":"8","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1038\/ni.3754","article-title":"Nutrition, Inflammation and Cancer","volume":"18","author":"Zitvogel L.","year":"2017","journal-title":"Nature Immunology"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.aohep.2020.08.067","article-title":"Usefulness of Neutrophil\u2010To\u2010Lymphocyte Ratio (NLR) as a Prognostic Predictor After Treatment of Hepatocellular Carcinoma","volume":"22","author":"Mouchli M.","year":"2021","journal-title":"Annals of Hepatology"},{"issue":"17","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12175434","article-title":"The Prognostic Nutritional Index (PNI): A New Biomarker for Determining Prognosis in Metastatic Castration\u2010Sensitive Prostate Carcinoma","volume":"12","author":"Ellez H. I.","year":"2023","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"10273","DOI":"10.2147\/JIR.S499094","article-title":"The Effect of Systemic Immune\u2010Inflammatory Index (SII) and Prognostic Nutritional Index (PNI) in Early Gastric Cancer","volume":"17","author":"Jing Y.","year":"2024","journal-title":"Journal of Inflammation Research"},{"issue":"1","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12957-023-02972-4","article-title":"The Advanced Lung Cancer Inflammation Index Is a Prognostic Factor for Gastrointestinal Cancer Patients Undergoing Surgery: A Systematic Review and Meta\u2010Analysis","volume":"21","author":"Liu X. R.","year":"2023","journal-title":"World Journal of Surgical Oncology"},{"issue":"1","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/PAS.0000000000000535","article-title":"A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process","volume":"40","author":"Carr N. 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A.","year":"2015","journal-title":"Journal of Thoracic Oncology"},{"issue":"1","key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/1471-2407-13-158","article-title":"Advance Lung Cancer Inflammation Index (ALI) at Diagnosis Is a Prognostic Marker in Patients With Metastatic Non\u2010Small Cell Lung Cancer (NSCLC): A Retrospective Review","volume":"13","author":"Jafri S. 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L.","year":"2021","journal-title":"Orphanet Journal of Rare Diseases"},{"issue":"1","key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1245\/s10434-021-10372-9","article-title":"A Proposal for Modification of the PSOGI Classification According to the ki\u201067 Proliferation Index in Pseudomyxoma Peritonei","volume":"29","author":"Arjona\u2010S\u00e1nchez \u00c1.","year":"2022","journal-title":"Annals of Surgical Oncology"},{"issue":"8","key":"e_1_2_13_21_1","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/j.ejso.2023.03.206","article-title":"External Multicentre Validation of Pseudomyxoma Peritonei PSOGI\u2010Ki67 Classification","volume":"49","author":"Arjona\u2010Sanchez A.","year":"2023","journal-title":"Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology"},{"issue":"2","key":"e_1_2_13_22_1","first-page":"173","article-title":"Carbohydrate Antigen 19\u20109 (CA 19\u20109) is an Independent Prognostic Indicator in Pseudomyxoma Peritonei Post Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy","volume":"4","author":"Koh J. L.","year":"2013","journal-title":"Journal of Gastrointestinal Oncology"},{"issue":"5","key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1001\/jamasurg.2023.0112","article-title":"Development and Validation of Nomograms to Predict Survival in Patients Undergoing Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin","volume":"158","author":"Chandrakumaran K.","year":"2023","journal-title":"JAMA Surgery"},{"key":"e_1_2_13_24_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.humpath.2021.04.007","article-title":"Ki67 Does Not Predict Recurrence for Low\u2010Grade Appendiceal Mucinous Neoplasms With Peritoneal Dissemination After Cytoreductive Surgery and HIPEC","volume":"113","author":"Ward E. 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H. C.","year":"2017","journal-title":"European Journal of Surgical Oncology"},{"issue":"1","key":"e_1_2_13_31_1","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1186\/s12957-023-03232-1","article-title":"Long\u2010Term Survival in Patients With PMP: A Single\u2010Institutional Retrospective Study From China","volume":"21","author":"Yang R.","year":"2023","journal-title":"World Journal of Surgical Oncology"},{"issue":"1","key":"e_1_2_13_32_1","first-page":"2","article-title":"Nutrition Care for the Patient Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy","volume":"46","author":"Figueiroa S.","year":"2024","journal-title":"Support Line: Newsletter of Dietitians in Nutrition Support"},{"issue":"5","key":"e_1_2_13_33_1","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.clnu.2016.08.023","article-title":"Preoperative Hypoalbuminemia Is Associated With Worse Outcomes in Colon Cancer Patients","volume":"36","author":"Haskins I. 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