Comparative prognostic value of preoperative SII, NLR, and MLR and their association with TNM staging in gallbladder cancer: A multicenter retrospective study

IF 5 2区医学 Q2 Medicine

Translational Oncology Pub Date : 2026-02-01 Epub Date: 2025-12-10 DOI:10.1016/j.tranon.2025.102627

Zhenhao Huang , Jing Luo , Jintong He , Qihui Hu , Rui Liao , Jie Xu , Peng Guo , Zhipeng Liu , Nan You , Baoyong Zhou , Rui Tao

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引用次数: 0

Abstract

Background

Gallbladder cancer (GBC) has poor prognosis, and reliable preoperative biomarkers remain limited. Systemic inflammation-based indices, including systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR), may predict outcomes, but their comparative value and association with TNM stage are unclear.

Methods

This multicenter retrospective study included 210 patients who underwent curative-intent resection for GBC (2015–2023). Preoperative SII, NLR, and MLR were calculated from peripheral blood counts. Prognostic performance was evaluated by time-dependent ROC, Kaplan–Meier, and Cox regression analyses. Restricted cubic spline models assessed non-linear associations. Associations with TNM stage were analyzed using the Jonckheere–Terpstra trend test, and stratified survival analysis was conducted.

Results

SII showed the highest predictive accuracy for overall survival (OS, AUC = 0.745) and recurrence-free survival (RFS, AUC = 0.689), outperforming NLR and MLR. In multivariable analysis, only elevated SII independently predicted poorer OS (HR = 4.601, 95% CI: 1.178–17.965, P = 0.028). Restricted cubic spline revealed an “S-shaped” non-linear relationship between SII and OS risk and a linear association with RFS. SII levels significantly increased with advancing TNM stage (P = 0.042) and provided superior prognostic stratification in advanced disease, while NLR and MLR showed weaker stage-related trends.

Conclusions

Among SII, NLR, and MLR, preoperative SII showed comparatively stronger and more consistent associations within this retrospective multicenter cohort. SII independently predicted OS, correlated with TNM stage, and appeared to offer better stratification in advanced disease. As a simple and readily available biomarker, SII may be considered to complement TNM staging for preoperative risk assessment; however, these findings should be interpreted cautiously and require confirmation in prospective multicenter studies.

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胆囊癌术前SII、NLR和MLR的比较预后价值及其与TNM分期的关系：一项多中心回顾性研究

胆囊癌（GBC）预后不良，可靠的术前生物标志物仍然有限。基于全身性炎症的指标，包括全身性免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）和单核细胞与淋巴细胞比值（MLR），可以预测预后，但它们的比较价值以及与TNM分期的关系尚不清楚。方法本多中心回顾性研究纳入了210例2015-2023年行有意治愈性GBC切除术的患者。术前SII、NLR和MLR通过外周血计数计算。采用时间相关ROC、Kaplan-Meier和Cox回归分析评估预后。限制三次样条模型评估非线性关联。采用Jonckheere-Terpstra趋势检验分析与TNM分期的关系，并进行分层生存分析。结果sii对总生存期（OS, AUC = 0.745）和无复发生存期（RFS, AUC = 0.689）的预测准确率最高，优于NLR和MLR。在多变量分析中，只有SII升高独立预测较差的OS （HR = 4.601, 95% CI: 1.178-17.965, P = 0.028）。限制三次样条曲线显示SII与OS风险呈“s”形非线性关系，与RFS呈线性相关。SII水平随着TNM分期的进展而显著升高（P = 0.042），在晚期疾病中提供了更好的预后分层，而NLR和MLR表现出较弱的分期相关趋势。结论在SII、NLR和MLR中，术前SII在回顾性多中心队列中表现出相对更强和更一致的相关性。SII独立预测OS，与TNM分期相关，并且似乎在晚期疾病中提供更好的分层。作为一种简单易得的生物标志物，SII可作为TNM分期的补充，用于术前风险评估；然而，这些发现应谨慎解释，并需要在前瞻性多中心研究中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational Oncology ONCOLOGY-

CiteScore

8.40

自引率

2.00%

发文量

314

审稿时长

54 days

期刊介绍： Translational Oncology publishes the results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of oncology patients. Translational Oncology will publish laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer. Peer reviewed manuscript types include Original Reports, Reviews and Editorials.