Objective  To explore the impact of the advanced lung cancer inflammation index (ALI) on the cancer mortality in patients with rheumatoid arthritis (RA) and its predictive value for prognosis.

Methods  The clinical data of RA patients in the National Health and Nutrition Examination Survey (NHANES) database in the United States from 1999 to 2018 were retrospectively analyzed. After adjusting for potential confounding factors, the Kaplan-Meier curve and multivariable Cox regression risk model were used to evaluate the associations between cancer mortality and ALI in RA patients. The restricted cubic spline (RCS) was used to quantify the nonlinear relationship between the two, and subgroup analysis was conducted to enhance the reliability of the results.

Results  A total of 2 562 RA patients were included and divided into triple subgroups (T1, T2 and T3) based on ALI levels, with 854 patients in each triple subgroup. The results showed that compared with the T1 group, the cancer mortality gradually decreased in the T2 group [hazard ratio (HR)=0.49, 95% confidence interval (CI): 0.33-0.65, P<0.001] and the T3 group (HR=0.32, 95%CI: 0.17-0.58, P<0.001). There was an L-shaped nonlinear negative correlation between ALI and the cancer mortality of RA patients. The critical value of ALI for the cancer mortality rate of RA patients was 96.77. Below this critical value, for each 10-unit increase in ALI, the risk of cancer death decreased by 10% (HR=0.90, 95%CI: 0.85-0.95, P<0.001); above this critical value, there was no significant association between the increase in ALI and the risk of cancer death in RA patients (HR=1.03, 95%CI: 0.97-1.09, P=0.321). Subgroup analysis showed no statistically significant differences among different subgroups (P>0.05).

Conclusion  ALI combines inflammatory and nutritional parameters and can be used as a cost-effective and readily available tool for guiding the clinical treatment and prognostic assessment of RA patients with malignant tumors.

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