Studies regarding the long-term outcomes of endoscopic submucosal dissection (ESD) performed in older patients with colorectal tumors are limited. Therefore, in this study, we aimed to analyze the long-term outcomes of older patients with colorectal tumors who underwent ESD and identify prognostic factors.

The data of patients aged ≥ 75 years who underwent ESD for colorectal tumors (adenoma and Tis/T1 colorectal cancer) at a single center were retrospectively analyzed. Prognostic factors for overall survival were analyzed using the Kaplan-Meier method and the Cox proportional hazard model.

Of the 156 patients included, 51 patients died during the follow-up period, among whom two deaths were due to colorectal cancer. The univariate analysis revealed that an age ≥83 years, Charlson Comorbidity Index ≥2, prognostic nutritional index <46, and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with poor overall survival. The multivariate analysis identified Charlson Comorbidity Index ≥2 (hazard ratio: 2.26; 95% confidence interval (CI): 1.24-4.13; p = 0.0008) and NLR ≥3 (hazard ratio, 1.98; 95% CI: 1.02-3.81; p = 0.042) as independent prognostic factors.

CCI and NLR may be useful parameters for decision-making in older patients undergoing colorectal ESD.

Several lines of treatment can be used sequentially in patients with metastatic colorectal cancer. We investigated the evolution of patient/tumor characteristics and their prognostic impact across treatment lines to develop an overall prognostic score (OPS).

Individual patient data from 48 randomized trials were analyzed. The end point was overall survival (from random assignment to death). Missing data were imputed. The complete data set was then separated into construction (80%) and validation sets (20%). The Cox's model was used to define risk groups for survival using the OPS. The discrimination capability was assessed in each treatment-line via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices. Internal validation was done in the validation set.

A total of 37,560 patients (26,974 in first-line [1L], 7,693 in second-line [2L], and 2,893 in third-line [3L]) were analyzed. Some clinical, biological, and molecular characteristics of patients/tumors included in therapeutic trials evolve over the lines. Seven independent prognostic variables were retained in the final multivariate model common to all lines: Eastern Cooperative Oncology Group performance status, hemoglobin, platelet count, WBC/absolute neutrophil count ratio, lactate dehydrogenase, alkaline phosphatase, and the number of metastatic sites. The OPS was used to define four patient subgroups with significantly different prognoses in 1L, 2L, and 3L, separately, with adequate C-indices: 0.65, 0.66, and 0.69 in the construction set and 0.65, 0.66, and 0.68 in the validation set, respectively. The OPS was not predictive, with 3L drugs (v placebo) or subsequent line (2L/1L or 3L/2L) extending survival in all prognostic groups.

The same prognostic model using practical variables can be used before all treatment lines. The OPS could better stratify patients in future clinical trials and help to therapeutic decision in routine practice.

The study aimed to determine and validate cut-off points for selected inflammatory markers to predict 30-day, 60-day and 90-day survival in patients with incurable cancer exclusively receiving palliative care.

Prospective cohort study with patients referred to the palliative care unit of a national reference centre for cancer in Brazil. The sample (n=2098) was randomised into development (n=1049) and validation (n=1049) groups. C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were evaluated. Time-dependent receiver operating characteristic curves were used to define the optimal cut-off points. Kaplan-Meier curves, Cox proportional hazards models and concordance statistic (C-statistic) were used to evaluate their predictive ability.

The optimal cut-off points related to 30-day, 60-day and 90-day mortality were, respectively, as follows: CRP ≥6.0 mg/L, ≥4.8 mg/L and ≥4.7 mg/L; CAR ≥2.0, ≥1.7 and ≥1.5; NLR ≥6.5, ≥5.8 and ≥5.7; PLR ≥298.0, ≥286.7 and ≥281.2; LMR ≥1.9, ≥2.2 and ≥2.0; PNI ≥35.5, ≥46.8 and ≥30.5; and SII ≥2254.4, ≥1983.0 and ≥1844.1. The inflammatory markers that showed discriminatory accuracy (CRP, CAR, NLR, PLR and SII) were selected for validation. These markers demonstrated predictive ability, with good discriminatory power (C-statistic ≥0.75).

Optimal cut-off points were validated for CRP, CAR, NLR, PLR and SII for use in the prognostic assessment of patients with incurable cancer exclusively receiving palliative care.

Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the blocks in laparoscopic colorectal surgery. Materials and Methods: A retrospective analysis was performed on patients with elective colorectal surgeries who received bilateral US TAP blocks in the supine position or US anterior QL block in the lateral position at the end of the surgery and before extubating, with Ropivacaine 0.25%. Total opioid consumption and time to first intravenous analgesic were noted. Results: Between January 2020 and December 2024, 410 patients underwent elective laparoscopic colorectal oncology surgery under general anesthesia, with peripheral nerve blocks. Of these, we analyzed 116 patients with localized diseases who underwent elective surgeries and who did not require conversion to classical surgery and received either QL or TAP blocks. A total of 62 patients underwent QL block and 54 received TAP block. For the primary outcome, in the QL group, significantly fewer opioids were used than in the TAP group (p < 0.001), and time to first rescue analgesic was prolonged in the QL group at 16 h (IQR 14-18) compared to the TAP group, where the requirement occurred earlier at 8 h (IQR 8-8) postoperatively (p < 0.001). Conclusions: Postoperative bilateral US anterior QL block reduced morphine consumption and improved time to rescue analgesia and LOS compared with midaxillary line bilateral US TAP block.

Talaromyces marneffei (T. marneffei) co-infection remains a significant cause of mortality in people living with HIV (PLWH). Although early detection of individuals at high risk is essential, there remains a lack of markers to predict outcomes. This multicenter retrospective study analyzed 282 PLWH (95 treatment-naïve T. marneffei co-infected, 187 without opportunistic infections) to evaluate six inflammatory indices: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-platelet ratio (NPR), and pan-immune inflammation value (PIV). Multivariate logistic regression and ROC analysis were performed to identify risk factors and prognostic performance. The results revealed that T. marneffei group exhibited significantly elevated levels of SII, NPR, NLR, and PLR (P <0.001), with lower LMR (P <0.001) and PIV levels (P =0.014). Logistic regression identified thrombocytopenia (P =0.026), hypoalbuminemia (P =0.031), and lower CD4+ T-cell counts (P =0.011) as independent predictors of HIV-TM coinfection. Among the T. marneffei group, survivors (n=80) and non-survivors (n=15) exhibited distinct inflammatory profiles: NLR demonstrated optimal mortality prediction (AUC=0.788, P <0.001), outperforming NPR (AUC=0.671, P <0.001). Multivariate analysis confirmed NLR as the sole mortality predictor (P =0.041), with restricted cubic spline analysis indicating a non-linear NLR-mortality relationship. In conclusion, we found that NLR represents a reliable prognostic marker for PLWH co-infected with T. marneffei.

The stress-associated chaperone system is an actionable target in cancer therapies. It is ubiquitously upregulated in cancer tissues and enables tumorigenicity by stabilizing oncoproteins. Most inhibitors target the key component, heat-shock protein 90 (HSP90). Although HSP90 inhibitors are highly tumor-selective, they fail in clinical trials. These failures are partly due to interference with a negative regulatory feedback loop in the heat-shock response (HSR): in response to HSP90 inhibition, there is compensatory synthesis of stress-inducible chaperones, mediated by the transcription factor heat-shock-factor 1 (HSF1). We recently identified that wild-type p53 reduces the HSR by repressing HSF1 via a p21-CDK4/6-MAPK-HSF1 axis. Here, we test whether in HSP90-based therapies, simultaneous p53 activation or direct cell cycle inhibition interrupts the deleterious HSF1-HSR axis and improves the efficiency of HSP90 inhibitors. We found that the clinically relevant p53 activator Idasanutlin suppresses the HSF1-HSR activity in HSP90 inhibitor-based therapies. This combination synergistically reduces cell viability and accelerates cell death in p53-proficient colorectal cancer (CRC) cells, murine tumor-derived organoids, and patient-derived organoids (PDOs). Mechanistically, upon combination therapy, CRC cells upregulate p53-associated pathways, apoptosis, and inflammatory pathways. Likewise, in a CRC mouse model, dual HSF1-HSP90 inhibition represses tumor growth and remodels immune cell composition. Importantly, inhibition of the cyclin-dependent kinases 4/6 (CDK4/6) under HSP90 inhibition phenocopies synergistic repression of the HSR in p53-proficient CRC cells. Moreover, in p53-deficient CRC cells, HSP90 inhibition in combination with CDK4/6 inhibitors similarly suppresses the HSF1-HSR and reduces cancer growth. Likewise, p53-mutated PDOs respond to dual HSF1-HSP90 inhibition, providing a strategy to target CRC independent of the p53 status. In sum, we provide new options to improve HSP90-based therapies to enhance CRC therapies.

Sepsis-associated acute kidney injury (SA-AKI) significantly impacts global health. Early identification of SA-AKI patients at inflammatory and immune risk, followed by timely interventions, is critical for improving outcomes. The pan-immune-inflammation value (PIV) reflects systemic inflammation and immune status. However, its prognostic value in SA-AKI remains unexplored.

This retrospective cohort study analyzed SA-AKI patients in the MIMIC-IV database. Cox regression assessed the association between PIV and mortality, while restricted cubic spline (RCS) regression explored the relationship between PIV and 30-day and 365-day mortality.

A total of 2,473 SA-AKI patients in our study were categorized into PIV quartiles: T1 (≤ 214), T2 (214-679), T3 (679-2,039), and T4 (> 2,039). PIV showed a nonlinear association with mortality. Higher PIV quartiles were linked to increased mortality, with 30-day rates of 26%, 22%, 35%, and 41% (P < 0.001) and 365-day mortality rates of 34%, 31%, 46%, and 54% (P < 0.001). Adjusted hazard ratios (HR) for 30-day mortality across quartiles were 1.00 (reference), 1.04(0.82, 1.31), 1.54 (1.25, 1.9), and 1.62 (1.32, 1.98), respectively. For 365-day mortality, the HR and 95% CI were 1.00 (reference), 1.06 (0.87, 1.30), 1.58 (1.32, 1.90), and 1.70 (1.42, 2.03). After adding PIV to SOFA score, the integrated discrimination improvement (IDI) for 30-day mortality was 0.005, and the net reclassification improvement (NRI) was 0.103. For 365-day mortality, the IDI was 0.009, and the NRI was 0.124. Regarding the APACHE II score, the IDI for 30-day mortality was 0.003, and the NRI was 0.081. For 365-day mortality, the IDI was 0.006, and the NRI was 0.107.

Elevated PIV independently predicts both short- and long-term adverse outcomes in SA-AKI patients. Incorporating PIV into established critical illness prediction models, such as SOFA and APACHE II, enhances their prognostic accuracy.

The aim of this study was to develop a new, less cumbersome index for determining sarcopenia using axial slice images from computed tomography (CT) as a surrogate for the skeletal muscle index (SMI) measured by bioelectrical impedance analysis (BIA).

We devised the JOHAS index (Judgment of Objective Hyper-steatosis and Atrophy in Sarcopenia), calculated from the measurements of the iliopsoas and erector spinae muscles in the axial CT slices at the L4 lumbar vertebral level. The JOHAS index is defined as: JOHAS index = ∑ [(cross-sectional area of each muscle [cm2]/patient height [cm]) × (CT number + 108)], where ∑ is defined as the sum of the values in the bracket for iliopsoas and erector spinae muscles on both sides, and 108 is the adjustment factor. The accuracy of the JOHAS index for identifying sarcopenia, as determined by BIA, was examined using a receiver operating characteristic (ROC) curve analysis on a sample of 639 patients (331 men and 308 women).

The JOHAS index was able to discriminate sarcopenia with an area under the curve (AUC) of around 0.88 in men and 0.75 in women. The JOHAS index outperformed commonly used indices such as the psoas muscle index, erector spinae muscle index, intramuscular adipose tissue content, prognostic nutritional index, and neutrophil/lymphocyte ratio.

The JOHAS index is a promising, pragmatic surrogate for SMI measured by BIA. The recommendable cut-off values are 43 (sensitivity 0.7722, specificity 0.8362) for men and 32 (sensitivity 0.6377, specificity 0.7423) for women.

This study aimed to evaluate the prognostic value of pre-treatment blood cell counts in patients with brain metastasis (BM) from non-small cell lung cancer (NSCLC) who were treated using linear accelerator (linac)-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator. Between January 2011 and November 2022, 271 consecutive patients underwent linac-based SRS/fSRT for BM from NSCLC. Thirty patients with insufficient blood test data during this period were excluded from this analysis. Thirty-five patients with steroid intake at the time point of the blood test and 18 patients with higher C-reactive protein were excluded. Thus, 188 patients were eventually enrolled in this study. The median follow-up period after SRS/fSRT was 21 months (range: 0-121 months), and the median survival time after SRS/fSRT was 19 months. Neutrophil-lymphocyte ratio ≥ 1.90, lymphocyte-monocyte ratio ≤ 1.67 and systemic inflammation response index (SIRI) ≥ 2.95 were unfavorable predictors of prognosis for patients who underwent SRS/fSRT for BM from NSCLC. Cox proportional-hazard multivariate analysis revealed that the SIRI was independent prognostic factors for increased risk of death. Thus, simple, less expensive, and routinely performed pre-treatment blood cell count measurements such as SIRI can predict the overall survival of patients treated with SRS/fSRT for BM from NSCLC.

This study aimed to develop a prognostic model for colorectal cancer (CRC) patients using biomarkers from routine preoperative peripheral blood examinations combined with clinical factors.

This observational study comprised CRC patients (stages I-III) who underwent curative surgery between January 2011 and December 2019. Study variables included patient demographics, tumour characteristics, and immune/inflammatory markers from preoperative blood tests. Cut-off thresholds for continuous variables were determined using maximally selected rank statistics. Univariate and multivariate analyses identified variables associated with 3-year cancer-specific survival (CSS) and disease-free survival (DFS). Cox regression models were developed and validated using a random split-sample approach. Nomograms based on these models were constructed, and receiver operating characteristic (ROC) curves were generated for 12, 24 and 36 months.

A total of 764 patients were included. Independent factors for 3-year DFS included laparoscopic surgery, prognostic nutritional index (PNI), neutrophil count, lymphocyte count, and Charlson comorbidity index. The DFS prediction model showed AUC values of 66.6%, 64.8%, and 69% for years 1, 2, and 3, respectively. For CSS, independent factors included age, systemic immune-inflammation index (SII), serum albumin, and platelet count, with AUC values of 89.2%, 76.8%, and 71% for years 1, 2, and 3. The most significant contributors to the CSS model were SII and platelet cut-off values.

Inflammatory biomarkers combined with clinical parameters robustly predict 3-year survival outcomes in CRC patients undergoing curative resection. These findings highlight the importance of systemic inflammation in CRC prognosis and support its inclusion in preoperative risk stratification.

Neutrophil-to-lymphocyte ratio (NLR) can be treated as a simple indicator of patients' immune status by representing the state of the systemic inflammatory response. Immunotherapy now is the accepted second-line treatment for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC). However, the significance of NLR in patients with R/M NPC undergoing treatment with PD-L1 (programmed cell death-ligand 1) inhibitors is still uncertain.

We analyzed the relationship between baseline NLR with 153 patients' efficacy and survival from a multicenter, prospective, Phase 2 study. We employed restricted cubic spline plots to get the nonlinear relationship between NLR and progression-free survival (PFS) or overall survival (OS). We identified the ideal cut-off value through the analysis of the receiver operating characteristic curve (ROC curve). We used Logistic regression, Cox regression, Log-rank test, and Kaplan-Meier method to analyze the association between NLR and patients' disease control rate (DCR) and PFS or OS.

The ideal threshold value for NLR was 2.826. NLR was identified as a significant independent predictor of DCR (OR = 0.17, 95% CI = 0.05-0.48, p = 0.001), indicating that a higher NLR is associated with worse DCR. NLR (AUC = 0.634) showed superior predictive capability for DCR in comparison to lymphocytes (AUC = 0.602) and neutrophils (AUC = 0.593). High NLR values were risk factors both for poor PFS (HR = 2.53, 95% CI = 1.58-4.06, p < 0.001) and OS (HR = 3.89, 95% CI = 2.09-7.24, p < 0.001).

Elevated NLR is strongly associated with lower response to treatment and reduced survival rates in patients with R/M NPC being treated with PD-L1 inhibitors. Patients with high NLR values have poor efficacy and survival.

This study aims to investigate the prognostic significance of dynamic hematological and clinical characteristics and to construct nomograms to predict overall survival (OS) in patients with cervical carcinoma who underwent radical radiotherapy.

The study analyzed patients with cervical cancer who underwent radical radiotherapy at The University of Hong Kong-Shenzhen Hospital between January 2015 and June 2022 and were staged as IB1 to IVA according to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system. We identified predictive factors through univariate and multivariate cox regression analyses. Two multivariate analyses integrating different groups of variables were conducted independently. Concordance index (C-index), receiver operating characteristic (ROC), and Kaplan-Meier curves were used to evaluate the nomograms. Bootstrap validation was performed to determine the accuracy of the nomogram using 1000 resamples. The performances of proposed nomograms and FIGO 2018 staging system were compared to assess the prognostic value of hematological and inflammatory markers.

One hundred fifty-nine patients were included in this retrospective analysis. The median follow-up time was 41.37 months, and the 3-year OS rate was 82.6%. The first multivariate analysis of pre-treatment clinical factors and all hematological variables showed that FIGO2018 staging, and pre-treatment albumin levels were associated with 3-year OS. The final multivariate analysis incorporating all clinical factors, hematological variables, and inflammatory markers identified the following prognostic factors: FIGO2018 staging, rate of tumor shrinkage before brachytherapy, pre-treatment albumin levels, treatment times, minimum neutrophils during treatment, concurrent chemotherapy cycles, and lymphopenia grade. Calibration plots showed agreement between the OS predicted by the nomograms and actual OS. Kaplan-Meier curves demonstrated that patients in the high-risk group had shorter OS than those in the low-risk group (P ≤ 0.001). The C-index for the two nomograms was superior to that of the current FIGO2018 staging system, with values of 0.709 (95% Confidence Interval [CI], 0.622-0.795) and 0.803 (95% CI, 0.729-0.877), compared to 0.593 (95% CI, 0.508-0.678) for the FIGO system.

We developed and validated nomograms to predict OS in cervical cancer patients staged IB1 to IVA who underwent radical radiotherapy RT. The prognostic significance of dynamic changes in blood and inflammatory markers has been confirmed. The proposed nomogram exhibits robust predictive capabilities for estimating OS in these patients, facilitating risk stratification and individualized treatment.

To identify the inflammation indexes associated with the severity and functional prognosis in ischemic stroke.

A prospective study was conducted with ischemic stroke cases included in the i-ReNe clinical registry. Patients were divided into groups according to the severity on admission measured by the National Institutes of Health Stroke Scale (NIHSS) and the functional prognosis at 30 and 90 days of discharge measured by the modified Rankin Scale (mRS).

We included 145 patients with a mean age of 61.5 ± 12.75, 97 (66.9%) were men. The leukocyte and neutrophil counts, Neutrophil-to-Lymphocyte ratio (NLR), Derived Neutrophil-to-Lymphocyte ratio (dNLR), Platelet-to-Lymphocyte ratio (PLR), Segmented Neutrophil-to-Monocyte ratio (SeMo ratio), and Systemic Immune-inflammation index (SII) were higher in moderate-to-severe stroke (NIHSS ≥6). NLR, PLR, SeMo ratio, and SII were higher in the group with severe disability and death at 30 days (mRS ≥4). In the multiple logistic regression analyses, SeMo ratio >14.966 and SII >623.723 were associated with moderate-to-severe stroke (NIHSS ≥6). In addition, SeMo ratio >7.845 was associated with severe disability and death at 30 days (mRS ≥4).

Systemic inflammation indexes could be rapid and low-cost markers used in the initial evaluation of ischemic stroke, whose values could help to stratify patients according to their severity and functional prognosis. This is the first study to establish a relationship between ischemic stroke and the SeMo ratio.

Activation of the systemic inflammatory response (SIR) is associated with inferior outcomes across a spectrum of disease. Routinely available measures of the SIR (neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory grade (SIG)) have been shown to provide prognostic value in patients undergoing surgical intervention. The present study aimed to review the literature describing the prognostic association of NLR, PLR, SII and SIG in patients undergoing intervention for abdominal aortic aneurysm (AAA).

This PRISMA guidelines were followed. The MEDLINE database was interrogated for relevant studies investigating the effect of peri-operative systemic inflammation-based prognostic systems on all-cause mortality in patients undergoing OSR and EVAR for AAA. Inter-study heterogeneity precluded meaningful meta-analysis; qualitative analysis was instead performed.

There were 9 studies included in the final review reporting outcomes on a total of 4571 patients; 1256 (27 %) patients underwent OSR, and 3315 (73 %) patients underwent EVAR. 4356 (95 %) patients underwent a procedure for unruptured AAA, 215 (5 %) patients underwent an emergency procedure for ruptured AAA0.5 studies reported early (inpatient or 30-day) mortality; 2 of these found that elevated NLR predicted inferior survival, however PLR did not provide prognostic value. 6 studies reported long-term mortality; elevated NLR (5 studies), PLR (1 study), and SIG (1 study) predicted inferior survival.

It appears that activation of the SIR is associated with inferior prognosis in patients undergoing intervention for AAA, however the evidence is limited by heterogenous methodology and lack of consensus regarding optimal cutoff.

CRD42022363765.

Anastomotic leakage (AL) is one of the most important complications that occurs after upper gastrointestinal surgery, registering rates of 20-30% after esophagectomy. The role of systemic inflammatory biomarkers to predict anastomotic leaks is controversial and needs systematization.

A systematic review based on the PRISMA guidelines criteria was performed. PubMed, Scopus, and Embase were queried using MESH Terms and All Fields key words to identify studies investigating a range of immune-inflammatory factors in predicting AL.

Twenty-four studies were included in this review. The total number of included patients was 5903, ranging in each study from 42 to 612. The included studies reported patients that underwent different techniques of esophagectomy (Ivor Lewis, McKeown, Orringer or thoracoabdominal esophagectomy) and 23 out of 24 studies included patients that underwent neoadjuvant treatment. While different biomarkers at different timepoints were analyzed, most studies have indicated postoperative biomarkers, between day 3 and day 5 to reach statistical significance.

Systemic inflammatory biomarkers represent potential risk stratification and predicting tools for AL after esophageal surgery, but more studies need to be conducted to validate their clinical utility.

Lactate has long been recognized as a key prognostic biomarker in sepsis. Similarly, the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) has been investigated in various conditions, including sepsis. Previous studies have explored the optimal NLR cutoff to differentiate sepsis survivors from nonsurvivors, predict bacteremia, diagnose sepsis, and assess mortality. This study compares the prognostic value of lactate and NLR in septic patients.

This prospective cohort study included 874 adult septic or septic shock patients presenting to a tertiary care center's Emergency Department between September 2018 and February 2021. The primary outcome was to compare the prognostic value of NLR and lactate regarding in-hospital mortality. Secondary outcomes compared their prognostic value in different septic subgroups.

Stepwise logistic regression showed NLR was not associated with in-hospital mortality (OR=1.003, p=0.544), while lactate was significantly associated with in-hospital mortality (OR=1.188, p<0.0001). There was no significant difference in the AUCs of NLR and lactate (0.552 vs 0.591, p=0.22). Lactate outperformed NLR in patients with albumin <30, those <65 years old, and those with sepsis from a urinary tract infection. No significant differences were found in AUCs between lactate and NLR in patients with septic shock, Lactate<2, Lactate≥2, diabetes, malignancy, chronic kidney diseases, other sources of infection, albumin ≥30 and age ≥ 65.

In this study, lactate but not NLR was associated with in-hospital mortality. There was no significant difference in the AUCs between lactate and NLR among sepsis patients and among most of the subgroups. However, lactate outperformed NLR in the following subgroups: albumin<30 g/L, patients <65 years old and patients with sepsis due to a urinary tract infection. Our results advocate for the continued use of serum lactate rather than NLR, despite its limitations, as a predictor of mortality among septic patients and the different subgroups in this study.

Prognostication by performance status (PS) assessment is a fundamental element of treatment decisions and clinical trial design in oncology, but it is limited by subjectivity and potential miscommunication between patient, physician, and family. Activity tracker offers the potential to collect a broad range of patient-generated data to supplement the assessment of PS.

Patients with metastatic NSCLC (mNSCLC) participated in a single institute, prospective, observational feasibility study conducted at Huntsman Cancer Institute. Patients were given a Fitbit® activity tracker, which collects their steps taken, distance moved, heart rate, and activity intensity. At baseline, PS was assessed by physicians and patients, and demographics and clinical data were collected. We defined novel indices of health: Heart rate Activity zone Mismatch (HAM) and excessive Sedentary Heart Rate (eSHR). We used multivariable Cox proportional hazards models adjusted for age, sex, and treatment line to estimate and test the prognostic ability of clinical and fitness metrics on overall survival (OS). Each prognostic model was evaluated using Harrell's concordance index (C-index).

Fifty-five patients with mNSCLC were enrolled. The median OS was 10.4 months (95% CI: 7.2, 15.2). PS-physician (HR = 2.0; P < .001) and Fitbit metrics were associated with OS, including daily total steps (1,000-steps) (HR = 0.8; P = .004), HAM (HR = 2; P = .02), eSHR (HR = 0.3; P = .001). The prognostic model that includes PS-physician was associated with the best concordance (C-index = 0.75), followed by daily total distance (C-index = 0.74) and steps (C-index = 0.73) CONCLUSIONS: Tracker-based measures were prognostic of survival in mNSCLC and may be useful as a supplement or alternative to PS in practice and clinical trials.

The tumor microenvironment (TME) is closely associated with the therapeutic response and clinical outcome of cancer drug therapies, which mainly include immunotherapy, chemotherapy and targeted therapy. Neutrophils that infiltrate tumors, also known as tumor-associated neutrophils (TANs), constitute a primary part of the TME. However, the functional importance of TANs in cancer drug therapy has long been overlooked because of their relatively short life span. Recent studies have shown that TANs play crucial protumoral or antitumoral roles in cancer drug treatment, largely because of their diversity and plasticity. This review describes the development, heterogeneity and recruitment of neutrophils in the context of cancer and emphasizes the role and mechanisms of TANs in cancer drug resistance. Additionally, several potential neutrophil-targeted strategies are discussed.

Background/Objectives: Hashimoto's thyroiditis (HT) is an autoimmune disorder characterized by chronic inflammation of the thyroid gland. Recent evidence indicates that the inflammation may extend beyond the thyroid. The study aims to explore the potential of complete blood count (CBC)-derived indices as markers of systemic inflammation in HT. Materials and Methods: This cross-sectional retrospective study from 1 January 2015, to 31 December 2023 included 147 pediatric HT patients and 144 apparently healthy controls. Thyroid profiles, antibodies, CBC, and protein electrophoresis data were collected from patient records. CBC-derived indices were calculated and compared between the HT and control groups, as well as among HT subgroups. Results: The median age of HT patients was 13.6 years (range: 11.2-15.5 years), with 66% being girls. The control group had a similar age and gender distribution, with a median age of 13.7 years (range: 11-15.8 years) and 70.8% girls. Of the HT patients, 50% had subclinical HT, 15% were euthyroid, and 34% had overt thyroid dysfunction. HT patients showed significantly higher neutrophil and lymphocyte counts, as well as all evaluated CBC-derived indices than controls (p < 0.001)). These differences were not significant among HT subgroups. Logistic regression indicated a strong association between an elevated neutrophil-to-lymphocyte ratio (NLR) and HT diagnosis (p < 0.001), while ROC analysis confirmed NLR as the most accurate CBC-derived marker for distinguishing HT from controls. Conclusions: Elevated NLR levels in pediatric HT patients provide additional evidence that inflammation may extend beyond the thyroid gland. These results support the potential of NLR as a reliable and accessible biomarker for evaluating inflammation in Hashimoto's thyroiditis.

Colorectal cancer (CRC) is a neoplasm with a high prevalence worldwide, with a multimodal treatment that includes a combination of chemotherapy, radiotherapy, and surgery in locally advanced stages with acceptable pathological complete response (pCR) rates, this has improved with the introduction of total neoadjuvant therapy (TNT) reaching pCR rates up to 37% in compare with classic neoadjuvant treatment (NAT) where pCR rates of around 20-25% are achieved. However, the patient population that benefits most from this therapy has not been determined, and there is a lack of biomarkers that can predict the course of the disease. Multiple biomarkers have been studied, ranging from hematological and molecular markers by imaging technique and combinations of them, with contradictory results that prevent their use in routine clinical practice. In this review, we evaluate the most robust prognostic biomarkers to be used in clinical practice, highlighting their advantages and disadvantages and emphasizing biomarker combinations and their predictive value.

In patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status.

We retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021. Liver resection procedures were categorized by surgical complexity using a 3-level complexity classification. Nutritional parameters (including cholinesterase and albumin levels) were evaluated together with well-known nutritional indexes, including the modified Glasgow Prognostic Score, prognostic nutritional index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and controlling nutritional status.

Of 1,258 patients, 570 (44.5%) experienced postoperative complications, with 506 (39.9%) requiring treatment (Clavien-Dindo grade II or greater). Multivariate logistic regression model analyses showed that cholinesterase and albumin levels, complexity classification, and open approach were associated with postoperative complications. The cholinesterase-liver resection complexity/approach model (area under the curve, 0.634) performed significantly better in predicting complications than the prognostic nutritional index (area under the curve, 0.560; P < .001), modified Glasgow Prognostic Score (area under the curve, 0.557; P < .001), controlling nutritional status (area under the curve, 0.502; P < .001), platelet-to-lymphocyte ratio (area under the curve, 0.513; P < .001), and neutrophil-to-lymphocyte ratio scores (area under the curve, 0.515; P < .001). On the basis of the cholinesterase-liver resection complexity/approach model, estimated complications ranged from 9.6% to 53.4%, and patients with well-maintained cholinesterase levels were estimated to have a 5-15% lower probability of complications than patients with impaired cholinesterase levels. This finding was validated with an external Western cohort.

The cholinesterase-liver resection complexity/approach model better predicted postoperative complications than nutritional indicators alone and may be useful for selecting patients who may benefit from nutritional support.

The aim of this study was to elucidate the clinical impact of the CALLY index in patients with gastric cancer (GC) undergoing gastrectomy.

Between January 2014 and December 2020, 617 patients who underwent gastrectomy for GC at the Osaka City General Hospital were enrolled in this study. The CALLY index was calculated using the following formula: [albumin (g/dL) × lymphocytes (/μl)]/[CRP (mg/dL) × 104]. We compared the predictive value of four biomarkers [CALLY index, modified Glasgow prognostic score (mGPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR)] for short- and long-term outcomes and focused on the CALLY index to elucidate its clinical value.

Receiver operating characteristic analysis showed that the area under the curve for the CALLY index was the highest among the four biomarkers. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the low and the high CALLY groups were statistically significant. Multivariate analysis identified the CALLY index as an independent factor for OS and CSS but not NLR or PLR. The mGPS was an independent factor for OS but not for CSS in multivariate analysis. Regarding complications, only the CALLY index was an independent predictor of major complications (≧ Clavien-Dindo grade 3) in multivariate analysis but not others.

The CALLY index may have a clinical value in predicting OS, CSS, and major complications in GC patients undergoing gastrectomy.

Direct-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR.

We recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC.

Totally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications.

The overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.

This study aims to develop and validate a predictive model that integrates clinical features, MRI radiomics, and nutritional-inflammatory biomarkers to forecast progression-free survival (PFS) in cervical cancer (CC) patients undergoing concurrent chemoradiotherapy (CCRT). The goal is to identify high-risk patients and guide personalized treatment.

We performed a retrospective analysis of 188 patients from two centers, divided into training (132) and validation (56) sets. Clinical data, systemic inflammatory markers, and immune-nutritional indices were collected. Radiomic features from three MRI sequences were extracted and selected for predictive value. We developed and evaluated five models incorporating clinical features, nutritional-inflammatory indicators, and radiomics using C-index. The best-performing model was used to create a nomogram, which was validated through ROC curves, calibration plots, and decision curve analysis (DCA).

Model 5, which integrates clinical features, Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), and MRI radiomics, showed the highest performance. It achieved a C-index of 0.833 (95% CI: 0.792-0.874) in the training set and 0.789 (95% CI: 0.679-0.899) in the validation set. The nomogram derived from Model 5 effectively stratified patients into risk groups, with AUCs of 0.833, 0.941, and 0.973 for 1-year, 3-year, and 5-year PFS in the training set, and 0.812, 0.940, and 0.944 in the validation set.

The integrated model combining clinical features, nutritional-inflammatory biomarkers, and radiomics offers a robust tool for predicting PFS in CC patients undergoing CCRT. The nomogram provides precise predictions, supporting its application in personalized patient management.

The tumor microenvironment (TME) has emerged as a significant prognostic factor. This study aimed to identify prognostic factors by combining clinicopathologic parameters and the TME biomarkers in patients who underwent surgery following neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC).

CD8+ T cells, CXCR3, CXCL10, and α-smooth muscle actin (α-SMA) were analyzed via immunohistochemical staining. We also incorporated AI-powered digital pathology to assess the spatial TME. The associations between these biomarkers, clinicopathologic parameters, and survival outcomes were evaluated.

CD8+ T cell expression, CXCR3 expression in tumor-infiltrating lymphocytes (TILs), and immune phenotypes were correlated. LARC patients with a high expression of CD8+ T cells, CXCR3 in TILs, and an inflamed phenotype had a significantly better prognosis than their counterparts did. In the multivariate analysis, the expression of CD8+ T cells and the inflamed/immune-excluded phenotype were significant tumor immune microenvironment (TiME) biomarkers for recurrence-free survival (RFS) but not for overall survival (OS). Notably, patients with the immune-desert phenotype had a poor prognosis regardless of pathologic stage, even if postoperative chemotherapy was administered (p < 0.001).

CD8+ T cells and AI-powered immune phenotypes, alongside clinical factors, can guide personalized treatment in LARC patients receiving nCRT. A therapeutic strategy to modify the TiME after nCRT could help reduce recurrence after surgery.

Introduction: Patients undergoing hemodialysis (HD) often exhibit an impaired cellular immune response, which may contribute to an increased susceptibility to infections and other complications. Th1 cells, a subset of T-helper cells, play a crucial role in cellular immunity. However, the modulation of Th1 cells by HD treatment remains unclear. Objective: This study aims to investigate the levels of circulating T cells, especially Th1 cells, and the neutrophil-to-lymphocyte ratio (NLR) in HD patients. Methods: We recruited 26 HD patients and 10 healthy volunteers. Demographical data were collected, and peripheral blood samples were analyzed. Absolute blood cell counts were determined, and T-cell populations were identified using flow cytometry. Th1 cells were defined as IFN-γ-producing CD4+ T cells after in vitro activation, and NLR was calculated through the ratio between the neutrophil and lymphocyte counts measured in peripheral blood. Results: We have observed a significant decrease in Th1 subpopulation frequency in HD patients, as well as significant correlations between immunological and demographic parameters, among which are the NLR values and the absolute values of T-cell subsets. Conclusions: These results seem to clarify the role of Th1 cells in modulating the immune responses of hemodialysis-treated patients, potentially considering its frequency as an indicator for CKD development.

Background/Objectives: Immunotherapy has changed the therapeutic approach for various solid tumors, especially lung tumors, malignant melanoma, renal and urogenital carcinomas, demonstrating significant antitumor activity, with tolerable safety profiles and durable responses. However, not all patients benefit from immunotherapy, underscoring the need for predictive biomarkers that can identify those most likely to respond to treatment. Methods: The integration of predictive biomarkers into clinical practice for immune checkpoint inhibitors (ICI) holds great promise for personalized cancer treatment. Programmed death ligand 1 (PD-L1) expression, tumor mutational burden (TMB), microsatellite instability (MSI), gene expression profiles and circulating tumor DNA (ctDNA) have shown potential in predicting ICI responses across various cancers. Results: Challenges such as standardization, validation, regulatory approval, and cost-effectiveness must be addressed to realize their full potential. Predictive biomarkers are crucial for optimizing the clinical use of ICIs in cancer therapy. Conclusions: While significant progress has been made, further research and collaboration among clinicians, researchers, and regulatory institutes are essential to overcome the challenges of clinical implementation. However, little is known about the relationship between local and systemic immune responses and the correlation with response to oncological therapies and patient survival.

A novel indicator of inflammation is the systemic immune-inflammation index (SII), and liver dysfunction is linked to the advancement of inflammation. In light of this, this study aims to look into any potential connections between SII and markers of liver injury.

A cross-sectional study was conducted using the National Health and Nutrition Examination (NHANES) dataset for 2017-2020. The linear relationship between SII and markers of liver injury was examined using multiple linear regression models. Examining threshold effects and fitted smoothed curves were utilized to describe nonlinear connections.

A total of 8213 adults aged 18-80 years participated in this population-based study. In the fully adjusted model, SII maintained a negative association with ALT(β = -0.003, 95%CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), and GGT(β = -0.004, 95% CI:-0.007, -0.000, P = 0.03791) and a positive association with ALP (β = 0.005, 95% CI:0.003, 0.007, P<0.00001). In subgroup analyses, it was found that SII remained negatively correlated with ALT, AST and GGT in gender, age and body mass index. SII was positively correlated with ALP at BMI≥25(kg/m2)(β = 0.005, 95% CI:0.003, 0.008, P = 0.00001), and was negatively correlated with ALT(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.003, P<0.00001) and GGT(β = -0.004, 95% CI:-0.008, -0.000, P = 0.02703) at BMI≥25, whereas no significant correlation was observed at BMI<25 (all P-values>0.05). Furthermore, the association between SII and markers of liver injury was nonlinear. By using a two-stage linear regression model for analysis, a U-shaped relationship was found to exist between SII and ALT with a turning point of 818.40(1,000 cells/μl). The inflection points of SII with AST and GGT were 451.20 (1,000 cells/μl) and 443.33 (1,000 cells/μl), respectively, and no significant inflection point with ALP was observed. Interaction tests demonstrated that SII correlation with ALT, AST, ALP, and GGT was not significantly different between strata (all p for interaction>0.05).

The research findings suggested that there was a negative correlation between SII and ALT, AST and GGT, and a positive correlation with ALP. However, larger prospective investigations are still greatly needed to confirm the findings.

This study evaluated the performance of the albumin-lymphocyte-globulin-C-reactive protein (CRP) (ALGC) index as a novel prognostic biomarker for hepatocellular carcinoma (HCC) after hepatectomy.

Patients (n = 178) who underwent hepatectomy for HCC (July 2010-December 2021) were analyzed. The ALGC index was calculated as ([albumin × lymphocyte]/[CRP × globulin × 104]). Patients were divided into a low ALGC group (<1.82; n = 81) and a high ALGC group (≥1.82; n = 97). The association of the ALGC index with survival was assessed by univariate and multivariate analyses.

The median overall survival (OS) was 100 (range: 1-149) months with 1-, 3-, and 5-year OS rates of 91.6%, 81.2%, and 64.2%, respectively. In univariate analysis, ALGC index (<1.82), alpha-fetoprotein (≥25 ng/mL), tumor size (≥3.5 cm), microvascular invasion, and multiple tumors were associated with shorter OS. ALGC index (<1.82) (hazard ratio [95% confidence interval]) (2.48 [1.407-4.513]; p = 0.001) and multiple tumors (1.92 [1.070-3.356]; p = 0.029) were independent predictors of OS in multivariate analysis.

ALGC index is a novel prognostic biomarker for HCC after hepatectomy. It may assist in treatment stratification and better management of patients with HCC.

Sarcopenia accompanied by systemic inflammation is associated with poor prognosis in patients with advanced hepatocellular carcinoma (HCC). However, the effect of sarcopenia combined with systemic inflammation on the prognosis of patients with advanced HCC who underwent hepatectomy is unclear. This study aimed to evaluate the effect of sarcopenia and inflammation on the prognosis of patients with advanced HCC.

This retrospective study included 151 patients recruited between July 2010 and December 2022. We defined advanced HCC as that presenting with vascular invasion or tumor size ≥2 cm or multiple tumors. Sarcopenia was assessed using the psoas muscle index. Preoperative inflammatory markers were used by calculating the prognostic nutritional index, albumin-globulin ratio (AGR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio. Cox regression analysis was performed to determine the prognostic factors for overall survival.

Of 151 patients, sarcopenia occurred in 84 (55.6 %). Sarcopenia was significantly associated with male sex, older age, body mass index (<25 kg/m2), and a higher NLR. In the multivariate analysis, AGR <1.25 (hazard ratio [HR], 2.504; 95% confidence interval [CI]: 1.325-4.820; p < 0.05); alpha-fetoprotein levels ≥25 ng/mL (HR, 1.891; 95% CI: 1.016-3.480; p = 0.04); and sarcopenia (HR, 1.908; 95% CI: 1.009-3.776; p < 0.05) were independent predictors of overall survival. The sarcopenia and low AGR groups had significantly worse overall survival than either the non-sarcopenia and high AGR or sarcopenia and low AGR groups.

Sarcopenia and AGR are independent prognostic factors in patients with advanced HCC. Thus, sarcopenia may achieve a better prognostic value when combined with AGR.

The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) are based on neutrophil, monocyte, platelet, and lymphocyte counts. The SIRI and SII are used to predict the survival of patients with malignant tumors. It is well known that the inflammatory immune response is closely related to cancer occurrence and progression. In the present study, we evaluated the potential prognostic significance of SIRI and SII in patients with primary central nervous system lymphoma (PCNSL).

Fifty-eight consecutive patients were enrolled in this study between November 2006 and May 2022. Among the 58 patients, 47 patients with sufficient blood test data and follow-up were analyzed. The patients with steroid intake at the time point of the blood test and higher C-reactive protein were excluded.

The median follow-up and survival times were 31 and 36 months, respectively. The optimal cutoff SIRI value was based on the receiver operating characteristic curve (ROC) for overall survival (OS) and stratified patients into low (< 1.43 × 109/L, n = 22) and high (≥ 1.43 × 109/L, n = 25) SIRI groups. The optimal cutoff SII value based on the ROC for OS stratified patients into low (< 694.9, n = 28) and high (≥ 694.9, n = 19) SII groups. A low SIRI value was associated with longer OS (p = 0.006). Furthermore, a low SII value was associated with longer OS (p = 0.044). The prognostic factors associated with prolonged survival in univariate analysis using the Cox proportional hazard model were age < 65 years, low SIRI, and low SII. The multivariate analysis demonstrated that age < 65 years and low SIRI independently predicted longer OS.

Simple, less expensive, and routinely ordered preoperative blood count assessments such as SIRI and SII predict the OS of patients with PCNSL. This study demonstrated that PCNSL is associated with pre-treatment systemic immune-inflammation states.

This study aimed to evaluate the effects of sarcopenia and inflammation on the prognosis of patients with pancreatic cancer after pancreaticoduodenectomy.

Eighty patients who had undergone pancreaticoduodenectomy for pancreatic cancer between July 2010 and December 2023 were included in this study. The psoas muscle index was used to assess sarcopenia. The C-reactive protein-to-albumin ratio, prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were used to calculate the preoperative inflammatory marker levels. The prognostic factors for overall survival were determined using Cox regression analysis.

Twenty-four patients were diagnosed with sarcopenia. Sarcopenia showed a significant association with advanced tumor stage. Univariate analysis revealed a significant reduction in overall survival in patients with a prognostic nutritional index of <45, C-reactive protein-to-albumin ratio of ≥0.047, cancer antigen 19-9 levels of ≥130 U/mL, sarcopenia, lymph node metastasis, and vascular invasion. Multivariate analysis revealed that a C-reactive protein-to-albumin ratio of ≥0.047 (hazards ratio, 3.383; 95% confidence interval: 1.384-8.689; p< 0.001), cancer antigen 19-9 levels of ≥130 U/mL (hazards ratio, 2.720; 95% confidence interval: 1.291-6.060; p = 0.008), sarcopenia (hazards ratio, 3.256; 95% confidence interval: 1.535-7.072; p = 0.002) and vascular invasion (hazards ratio, 2.092; 95% confidence interval: 1.057-4.170; p = 0.034) were independent predictors of overall survival. Overall survival in the sarcopenia and high C-reactive protein-to-albumin ratio groups was significantly poorer than that in the non-sarcopenia and low C-reactive protein-to-albumin ratio and sarcopenia or high C-reactive protein-to-albumin ratio groups.

Sarcopenia and a high C-reactive protein-to-albumin ratio are independent prognostic factors in patients with pancreatic cancer after pancreaticoduodenectomy. Thus, sarcopenia may have a better prognostic value when combined with the C-reactive protein-to-albumin ratio.

The prognosis for patients with cancer with brain metastasis (BM) requiring surgical removal is quite limited. Preoperative prognostic factors can provide meaningful information to surgeons, oncologists, and patients. This study evaluated the preoperative blood counts in patients with BM who were treated with surgical removal.

Between January 2011 and November 2021, 221 consecutive surgeries were conducted on 198 patients with BM. Among the 198 patients, 188 patients with sufficient blood test data and follow-up were analyzed in this study. The tumors originated from the lungs (n = 102, 54.3%), colon (n = 26, 13.3%), breast (n = 13, 6.9%), kidney (n = 8, 4.3%), stomach (n = 6, 3.2%), and others (n = 33, 17.6%). The blood test data included neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cell count, hemoglobin, and albumin.

The median follow-up and median survival times were both 11 months (range: 0-139 months). Higher neutrophil-lymphocyte ratio ≥ 3.17, platelet-lymphocyte ratio ≥112.7, systemic immune-inflammation index ≥594.4, systemic inflammation response index ≥1.25 were unfavorable predictors of prognosis for the patients treated with surgical removal for BM (P < 0.001). Furthermore, lower lymphocyte-monocyte ratio < 2.33 and prognostic nutritional index < 48.5 were unfavorable predictors.

Simple, less expensive, routinely ordered preoperative blood count assessments, such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index, can predict the overall survival of patients treated with surgical removal for BM.

To evaluate the prognostic significance of sarcopenia and systemic inflammatory markers in patients with surgically resected biliary tract cancer (BTC).

Between July 2010 and December 2022, 146 patients were recruited. Sarcopenia was assessed using the psoas muscle index. Preoperative inflammatory markers were used to calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. Cox regression analysis was performed to determine prognostic factors for overall survival (OS) and recurrence-free survival (RFS). P < 0.05 was considered statistically significant.

Sixty-four patients had sarcopenia. Sarcopenia was associated with body mass index (< 22 kg/m2), lymph node metastasis, and low PNI (< 42). R1/R2 resection (P = 0.02), sarcopenia (P < 0.001), lymph node metastasis (P = 0.007), intrahepatic cholangiocarcinoma (P < 0.001), and low PNI (P = 0.01) were independent predictors of OS, while male sex (P = 0.04), R1/R2 resection (P < 0.001), lymph node metastasis (P = 0.005), intrahepatic cholangiocarcinoma (P < 0.001), tumor differentiation (other than well; P = 0.003), and low PNI (P = 0.03) were independent predictors of RFS. Patients were stratified into no sarcopenia and high PNI (≥ 42; A), sarcopenia or low PNI (B), and sarcopenia and low PNI (C) groups. Group C had worse OS than the other two groups (P < 0.001 and P = 0.02, respectively).

Sarcopenia is associated with the PNI. Sarcopenia and the PNI are independent prognostic factors among patients with resected BTC. Sarcopenia may have better prognostic value when combined with the PNI.