Índice sistémico de inflamación e inmunidad como predictor independiente de malignidad en incidentalomas adrenales de 4-6 cm

IF 1.7 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI:10.1016/j.acuro.2025.501909

E.M. Yorulmaz , A. Gorgel , S. Ozcan , O. Kose , S.N. Gorgel , Y. Akin

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引用次数: 0

Abstract

Introduction

Adrenal incidentalomas (AI) measuring 4–6 cm present a diagnostic challenge, as size alone inadequately predicts malignancy and creates uncertainty in surgical decisions.

Objective

To evaluate the Systemic Immune-Inflammation Index (SII) as a predictor of malignancy in adrenal tumors ≥ 4 cm, with a focus on the 4–6 cm “gray zone.”

Methods

Retrospective single-center cohort of 91 adrenalectomy patients with AI ≥ 4 cm (ACC n = 19, ACA n = 72). A predefined subgroup included 46 patients with 4–6 cm tumors (ACC n = 9, ACA n = 37). SII was calculated from preoperative complete blood counts (CBC) as platelets × neutrophils / lymphocytes. Predictive performance was assessed using ROC analysis and logistic regression.

Results

In the ≥ 4 cm cohort, SII was higher in ACC vs. ACA (1107.4 vs. 711.3, p < 0.001). SII independently predicted ACC (per 100-unit increase: OR 0.78, 95% CI 0.67–0.90; p = 0.002). SII showed AUC 0.778 with a cut-off of 811 (sensitivity 78.9%, specificity 73.6%). Tumor size was not predictive (AUC ≈ 0.50). In the 4–6 cm subgroup, SII remained an independent predictor (per 100-unit increase: OR 0.61, 95% CI 0.45–0.82; p = 0.004), with AUC 0.898 at a cut-off of 945 (sensitivity 88.9%, specificity 83.8%).

Conclusions

SII—derived from routine CBC—is a low-cost, adjunctive biomarker that improves preoperative malignancy risk stratification beyond size in AI, particularly in 4–6 cm tumors. External prospective validation is warranted before routine implementation.

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全身炎症和免疫指数作为4-6厘米肾上腺素瘤恶性肿瘤的独立预测指标

肾上腺偶发瘤（AI）尺寸为4-6厘米，这是一个诊断挑战，因为仅凭大小不能充分预测恶性肿瘤，并给手术决策带来不确定性。目的评价系统性免疫炎症指数（SII）作为≥4cm肾上腺肿瘤恶性肿瘤的预测指标，重点关注4 - 6cm“灰色地带”。方法回顾性单中心队列研究91例AI≥4 cm的肾上腺切除术患者（ACC n = 19, ACA n = 72）。预定义亚组包括46例4-6 cm肿瘤患者（ACC n = 9, ACA n = 37）。SII通过术前全血细胞计数（CBC）计算血小板×中性粒细胞/淋巴细胞。采用ROC分析和logistic回归评估预测性能。结果在≥4 cm队列中，ACC组SII高于ACA组（1107.4比711.3,p < 0.001）。SII独立预测ACC（每100单位增加：OR 0.78, 95% CI 0.67-0.90; p = 0.002）。SII显示AUC为0.778，截止值为811（敏感性78.9%，特异性73.6%）。肿瘤大小无预测意义（AUC≈0.50）。在4-6 cm亚组中，SII仍然是一个独立的预测因子（每100个单位增加：OR 0.61, 95% CI 0.45-0.82; p = 0.004）， AUC为0.898，截止值为945（敏感性88.9%，特异性83.8%）。结论：来自常规cbc的si - i是一种低成本的辅助生物标志物，可改善AI术前恶性肿瘤风险分层，尤其是4-6 cm肿瘤。常规实施前需要进行外部前瞻性验证。

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

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.