Preoperative Aggregate Index of Systemic Inflammation is Associated with 30-Day Postoperative Pneumonia After Minimally Invasive Esophagectomy for Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study.

内容摘要

Postoperative pneumonia remains a frequent complication after esophagectomy for esophageal squamous cell carcinoma (ESCC). Simple preoperative inflammatory markers may help identify patients at higher perioperative risk. This retrospective cohort study included patients undergoing curative minimally invasive esophagectomy for ESCC from January 2023 to December 2025. The primary outcome was 30-day postoperative pneumonia or pneumonia during the index hospitalization, whichever occurred first. The aggregate index of systemic inflammation (AISI) was calculated from preoperative blood counts. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis and compared with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Associations were evaluated using hierarchical multivariable logistic regression. Among 446 eligible patients, 140 developed postoperative pneumonia, with an incidence of 31.4%. AISI showed good discriminatory performance for postoperative pneumonia (AUC, 0.795; 95% CI, 0.753-0.837) and had a higher AUC than NLR and PLR. In the fully adjusted model, higher AISI remained independently associated with postoperative pneumonia (per 100-unit increase: adjusted OR, 1.416; 95% CI, 1.301-1.576; P < 0.001). Preoperative AISI was independently associated with 30-day postoperative pneumonia after minimally invasive esophagectomy for ESCC and showed good discriminatory performance. AISI may serve as a simple preoperative risk-stratification marker, but external validation and prospective evaluation are needed before clinical use.