Jianxin Cai, Jiahua Tu, Ronglong Lin, Jianxin Xu
Background: Systemic inflammation plays a pivotal role in tumor progression and patient prognosis in non-small cell lung cancer (NSCLC). While preoperative inflammatory biomarkers have demonstrated prognostic utility, the additional value of perioperative dynamic changes remains insufficiently characterized. This study aimed to evaluate the prognostic significance of both preoperative inflammatory biomarkers and their perioperative alterations in patients undergoing curative-intent surgical resection for NSCLC. Methods: We conducted a retrospective cohort study of 368 consecutive patients who underwent surgical resection for pathologically confirmed NSCLC at our institution between January 2022 and December 2024. Preoperative blood samples were analyzed for complete blood count, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI) were calculated. Perioperative changes (Δ) were determined from postoperative day 1 values. Primary endpoints were disease-free survival (DFS), recurrence-free survival (RFS), and overall survival (OS) at 12 months. Kaplan-Meier analysis with log-rank tests and Cox proportional hazards regression were employed for survival analysis. Results: The median follow-up was 12.0 months. At 12 months, the DFS, RFS, and OS rates were 48.4%, 63.9%, and 75.0%, respectively. In univariate analysis, elevated NLR [≥2.78; hazard ratio (HR) =1.97, 95% confidence interval (CI): 1.48-2.62, P<0.001], elevated SII (≥585; HR =1.81, 95% CI: 1.35-2.42, P<0.001), low PNI (<47.8; HR =1.70, 95% CI: 1.28-2.27, P<0.001), elevated IL-6 (≥9.8 pg/mL; HR =1.71, 95% CI: 1.19-2.46, P=0.004), and high ΔNLR (≥7.8; HR =2.07, 95% CI: 1.50-2.85, P<0.001) were significantly associated with inferior DFS. Multivariate analysis identified advanced stage (IIB-IIIA; HR =1.41, 95% CI: 1.02-1.95, P=0.04), low PNI (HR =1.62, 95% CI: 1.21-2.17, P=0.001), elevated IL-6 (HR =1.67, 95% CI: 1.15-2.41, P=0.007), and high ΔNLR (HR =1.69, 95% CI: 1.15-2.50, P=0.008) as independent prognostic factors for DFS. The combined inflammatory index achieved superior discriminatory performance [area under the curve (AUC) =0.712] compared with individual markers. Conclusions: Perioperative inflammatory biomarkers, particularly the combination of preoperative PNI, IL-6, and perioperative ΔNLR, provide robust prognostic stratification in surgically resected NSCLC. Integration of these readily accessible biomarkers into clinical decision-making may facilitate personalized surveillance strategies and adjuvant therapy selection.