Sencan Akdag

Background/Objectives: Postoperative intensive care unit (ICU) disposition after anatomical lung resection is usually planned preoperatively, but the final care pathway may be substantially influenced by intraoperative events. We evaluated actual postoperative ICU admission among patients with a documented preoperative ICU monitoring recommendation and compared preoperative-only and perioperative triage approaches. Methods: In this retrospective single-centre cohort study, 1060 adults undergoing elective anatomical lung resection for non-small cell lung cancer (NSCLC) between January 2019 and December 2025 were screened; 159 patients with a documented preoperative ICU monitoring recommendation constituted the analytical cohort. A clinically pre-specified primary perioperative model incorporating operative duration, intraoperative complication, chronic obstructive pulmonary disease (COPD), and pre-existing arrhythmia was compared with a preoperative-only model and with an exploratory perioperative ICU triage score. Results: Actual postoperative ICU admission occurred in 45 patients (28.3%). Operative duration (adjusted odds ratio [OR] 1.012 per minute; 95% confidence interval [CI], 1.005–1.018; p < 0.001) and intraoperative complication (adjusted OR 15.002; 95% CI, 3.738–60.210; p < 0.001) were significantly associated with actual postoperative ICU admission. The primary perioperative model achieved an AUC of 0.802 (95% CI, 0.717–0.876), compared with 0.759 for the exploratory perioperative triage score and 0.665 for the preoperative-only model. Conclusions: Fewer than one-third of patients with a documented preoperative ICU monitoring recommendation underwent actual postoperative ICU admission. In this selected cohort, perioperative reassessment incorporating intraoperative information showed higher apparent discriminative performance than the preoperative-only approach while the exploratory score showed intermediate, hypothesis-generating performance. Because the outcome reflected observed institutional ICU disposition rather than independently adjudicated ICU-level care requirement, prospective multicentre validation using predefined ICU admission criteria is required before clinical implementation.

Background and Objectives: Pulmonary neuroendocrine carcinomas (NECs) are characterized by aggressive clinical behavior and heterogeneous postoperative outcomes. Early recurrence, often reflecting occult micrometastatic disease, remains a key determinant of prognosis and is insufficiently captured by conventional staging systems. We hypothesized that the lactate dehydrogenase-to-albumin ratio (LAR), as an integrative tumor–host biomarker, may provide biologically informed risk stratification in this setting. Materials and Methods: We conducted a multicenter retrospective cohort study including 88 patients with resected small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (LCNEC). Preoperative LAR and comparator inflammatory indices were evaluated. The primary endpoints were disease-free survival (DFS) and overall survival (OS), with early recurrence (≤12 months) as a prespecified secondary endpoint. Time-dependent receiver operating characteristic analyses, Cox proportional hazards models, and logistic regression analyses were applied within a predefined analytical framework. Results: Using a cut-off derived from 12-month DFS (LAR = 45.58), elevated LAR was associated with significantly shorter DFS (median 12.3 vs. 26.1 months; p = 0.018) and OS (median 20.7 vs. 52.8 months; p = 0.010). In multivariable analyses, LAR remained independently associated with both DFS (HR 1.012, 95% CI 1.001–1.023; p = 0.037) and OS (HR 1.016, 95% CI 1.005–1.027; p = 0.003). Elevated LAR was also associated with an increased risk of early recurrence (adjusted OR 4.656, 95% CI 1.520–14.262; p = 0.007). In time-dependent receiver operating characteristic (ROC) analyses, LAR demonstrated the highest overall discriminatory performance across evaluated biomarkers and showed a statistically significant advantage over neutrophil-to-lymphocyte ratio (NLR) for 24-month OS. Conclusions: Preoperative LAR captures a clinically relevant tumor–host phenotype associated with early disease progression and adverse survival outcomes in resected pulmonary NECs. As a biologically integrative and readily accessible biomarker, LAR may complement existing risk stratification strategies in this heterogeneous disease context. Prospective validation and integration into multimodal risk models are warranted.

Background/Objectives: Metachronous lung-limited oligometastatic disease represents a biologically heterogeneous state in which patient selection for pulmonary metastasectomy remains challenging. While systemic inflammation–nutrition indices have shown prognostic value across malignancies, their relevance in this strictly defined surgical setting is not well established. Methods: We conducted a retrospective single-center cohort study including 109 patients with isolated metachronous pulmonary recurrence who underwent curative intent R0 metastasectomy between September 2015 and April 2024. Preoperative systemic biomarkers, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), and monocyte-to-albumin ratio (MAR), were evaluated using receiver operating characteristic (ROC) analysis and multivariable Cox models to determine their association with overall survival (OS) and progression-free survival (PFS). Clinicopathological variables, such as lymph node involvement and metastatic burden, were incorporated into the adjusted models. Results: The median age of the cohort was 61 years (range, 29–82 years), and the sex distribution was balanced (48.6% female and 51.4% male), with 62.4% of patients being younger than 65 years. Among the systemic indices evaluated, monocyte-weighted biomarkers demonstrated the strongest prognostic performance. The MAR showed the highest discriminative ability for mortality (AUC, 0.749; p < 0.001), followed by the SIRI (AUC, 0.682; p = 0.007). In multivariable analyses, MAR independently predicted OS (p = 0.043) and PFS (p = 0.023), while SIRI independently predicted PFS (p = 0.043). Lymph node involvement remained the dominant adverse prognostic factor for both outcomes (p < 0.001); however, monocyte-weighted indices provided additional prognostic value beyond conventional anatomic criteria. Conclusions: Preoperative SIRI and MAR capture host immune–metabolic states that are relevant to postoperative trajectories and may refine risk stratification in candidates for pulmonary metastasectomy. These readily obtainable markers warrant prospective validation within biologically integrated selection frameworks.