Immune-Inflammatory Markers Associated With Occult Appendiceal Neoplasms in Patients With Acute Appendicitis

Area of Science:

• Surgical Oncology
• Gastroenterology
• Hematology

Background:

• Acute appendicitis severity varies, with some cases masking occult appendiceal neoplasms.
• Preoperative differentiation between simple appendicitis and neoplasm is challenging.
• Blood-derived inflammatory indices are explored as potential predictors of appendicitis severity and malignancy.

Purpose of the Study:

• To evaluate the diagnostic value of platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and CRP/SII.
• To predict complicated appendicitis and identify appendiceal neoplasms preoperatively.

Main Methods:

• Retrospective analysis of 837 appendectomies over 5 years.
• Classification of appendicitis severity using WSES criteria.
• Logistic regression and ROC analysis to assess diagnostic performance of inflammatory markers.

Main Results:

• Appendiceal neoplasms occurred in 1.1% of patients, often unsuspected intraoperatively.
• Higher PLR and SII were significantly associated with appendiceal neoplasms.
• PLR and SII demonstrated strong discrimination for neoplasms; CRP/SII was best for complicated appendicitis.

Conclusions:

• Inflammatory indices, particularly PLR and SII, are associated with appendiceal neoplasm and disease severity.
• These markers may assist in early surgical decision-making for high-risk patients.
• Prospective validation is required to refine the role of these markers in preoperative triage.