Scopus
Systemic immune-inflammation index as an independent predictor of malignancy in 4–6 cm adrenal incidentalomas
Actas Urologicas Espanolas · Mart 2026
Makale Bilgileri
DergiActas Urologicas Espanolas
Yayın TarihiMart 2026
Cilt / Sayfa50
Scopus ID2-s2.0-105028585252
Özet
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.
Yazarlar (6)
1
E. M. Yorulmaz
ORCID: 0000-0003-2109-2015
2
Ahmet Gorgel
3
S. Ozcan
4
O. Kose
5
Sacit Nuri Görgel
6
Y. Akin
Anahtar Kelimeler
Adrenal incidentaloma
Adrenocortical carcinoma
Inflammatory biomarkers
Preoperative risk stratification
Surgical decision-making
Systemic immune-inflammation index
Kurumlar
İzmir Kâtip Çelebi Üniversitesi
Izmir Turkey
Selçuk Üniversitesi
Selçuklu Turkey