Preoperative systemic immune-inflammation index for predicting the prognosis of thymoma with radical resection

Sep 24, 2026

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Background: Assess the clinical significance of the preoperative systemic immune-inflammation index (SII) in thymoma patients undergoing radical resection. Methods: Retrospective analysis of 425 patients at the First Affiliated Hospital of Nanjing Medical University (Sep 1, 2008–Dec 30, 2019), using routine preoperative blood tests and clinical features to calculate SII, PLR, and NLR. Results: Prognostic associations were found for multiple clinicopathologic variables and inflammation indices, with SII showing the highest predictive discrimination. Conclusion: Preoperative SII can predict thymoma prognosis after radical resection, warranting multicenter prospective validation.

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DOI: 10.1111/1759-7714.14854 ORIGINA L ARTICLE Preoperative systemic immune-inflammation index for predicting the prognosis of thymoma with radical resection Qifan Li 1 | Yiwei Pu 2 | Zetian Gong 3 | Yue Yu 3 | Wei Sun 3 | Zhike Cheng 1 | Wei Wang 3 | Jun Zhao 1 1Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China 2Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China 3Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China Correspondence Jun Zhao, Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China. Email: [zhaojia0327@126.com](zhaojia0327@126.com) Wei Wang, Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. [Email:](Email: wangwei-doctor@163.com)[ wangwei-doctor@163.com](Email: wangwei-doctor@163.com) Funding information Natural Science Foundation for the Youth of Jiangsu Province, Grant/Award Numbers: P112203521, BK20200196 Abstract Background: To investigate the clinical significance of preoperative systemic immune-inflammation index (SII) in patients with thymoma who underwent radical resection. Methods: This retrospective study involved 425 patients with thymoma who underwent radical resection at the First Affiliated Hospital of Nanjing Medical University between September 1, 2008 and December 30, 2019 . Data regarding routine preoperative blood tests and clinical features were collected to calculate and analyze the SII, platelet-to-lymphocyte ratio (PLR), and neutrophil-tolymphocyte ratio (NLR) . Results: Univariate analysis indicated that age (p = 0.021), tumor size (p = 0.003), extended resection (p < 0.001), Masaoka-Koga stage (p < 0.001), PLR (p = 0.012), NLR (p = 0.041), and SII (p = 0.003) were related to patient prognosis. A higher SII (>345.83) was a significant independent prognostic factor in this cohort (p = 0.001, HR = 5.756, 95% CI: 2.144–15.457) . Multivariate analysis showed that a high PLR was significantly associated with overall survival (OS) (p = 0.008, HR = 3.29, 95% CI: 1.371–7.896), while a high NLR was a significant independent prognostic factor for shorter OS (p = 0.024, HR = 2.654, 95% CI: 1.138–6.19) . SII had an area under the curve (AUC) of 70.6% (AUC = 0.706) exceeding the predictive value for PLR (AUC = 0.678) and NLR (AUC = 0.654) . Conclusion: Preoperative SII can predict the prognosis of thymoma patients who have undergone radical resection but further multicenter prospective studies are needed to investigate the role of SII in thymoma. KEYW ORD S NLR, PLR, prognosis, SII, thymoma INTRODUCTION Thymoma is a rare tumor with an annual incidence of 1 2.73 per 1 million person-years in China, 1 which is higher than in Europe2 and with a 5-year survival rate of approximately 78% .3 The tumor is usually a well-defined round orlobulated mass in the thymus4 typically graded using the Qifan Li, Yiwei Pu and Zetian Gong contributed equally to this work and share first authorship. Masaoka-Koga staging system.5 Completeness of resection is important for the prognosis;6 however, simple thymomectomy (ST) or thymothymectomy (TT) for stage I remains controversial.7–10 The WHO histological classification, 11,12 radical resection, 13 Masaoka-Koga stage and The American Joint Committee on Cancer’s AJCC Staging Manual, eighth edition (AJCC 8E) TNM staging system 12,14 are independent prognostic factors for disease-free survival (DFS) and overall survival (OS) . Intense efforts have been devoted to This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Thoracic

FAQs

What is the purpose of evaluating the preoperative SII in thymoma patients?

To investigate the clinical significance of the preoperative systemic immune-inflammation index (SII) in patients with thymoma who underwent radical resection.

How was SII (and related markers) calculated and analyzed in the study?

Routine preoperative blood tests and clinical features were collected to calculate SII, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), followed by univariate and multivariate analyses of prognosis.

Which inflammation index showed the strongest predictive value in this cohort?

SII demonstrated an area under the curve (AUC) of 70.6%, exceeding the predictive value for PLR (AUC = 0.678) and NLR (AUC = 0.654).

What further research is recommended after these findings?

Multicenter prospective studies are needed to further investigate and validate the role of SII in thymoma.

Sep 24, 2026

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