Association of preoperative inflammatory–nutritional indices and imaging-derived gallbladder wall thickness with neoplastic precursor lesions of gallbladder cancer: a retrospective cohort study

Neoplastic precursor lesions of gallbladder cancer include non-mass-forming flat dysplasia/biliary intraepithelial neoplasia and mass-forming intracholecystic papillary neoplasm, whereas isolated metaplasia is a non-neoplastic mucosal alteration. This study evaluated the associations of preoperative inflammatory–nutritional indices and imaging-derived gallbladder wall thickness with neoplastic precursor lesions. This retrospective single-center cohort included 180 patients who underwent cholecystectomy. The primary endpoint was low- or high-grade flat dysplasia/biliary intraepithelial neoplasia or intracholecystic papillary neoplasm; isolated metaplasia was reported separately. Apparent discrimination was evaluated using receiver operating characteristic analysis. Because only 10 primary outcome events were available, four separate age-adjusted parsimonious logistic regression models were fitted using log₂-transformed C-reactive protein, log₂-transformed systemic immune-inflammation index, imaging-derived gallbladder wall thickness, or log₂-transformed C-reactive protein–albumin–lymphocyte index. C-reactive protein and the composite index were compared using DeLong’s method. Restricted-cohort analyses addressed acute inflammatory presentations, and model discrimination and calibration were internally evaluated using 2,000 bootstrap resamples. Neoplastic precursor lesions were identified in 10 patients (5.6%): five had low-grade flat dysplasia/biliary intraepithelial neoplasia, three had high-grade disease, and two had intracholecystic papillary neoplasms. Seven additional patients (3.9%) had isolated metaplasia. Patients with neoplastic precursor lesions were older, had a more pronounced systemic inflammatory profile, lower C-reactive protein–albumin–lymphocyte index values, and greater gallbladder wall thickness. Apparent areas under the curve were 0.940 for C-reactive protein, 0.938 for the composite index, and 0.919 for wall thickness; C-reactive protein and the composite index did not differ significantly ( p = 0.625). All four candidate markers remained associated with the endpoint in separate age-adjusted models. Optimism-corrected C-statistics ranged from 0.915 to 0.946, and optimism-corrected calibration slopes ranged from 0.931 to 0.940. Findings were directionally preserved in restricted-cohort analyses. Preoperative inflammatory–nutritional markers and imaging-derived gallbladder wall thickness were associated with neoplastic precursor lesions. The observed signal probably reflects a shared biliary and systemic inflammatory environment rather than a direct systemic effect of microscopic lesions. The findings cannot be extrapolated to invasive gallbladder cancer, and these measures should not be used as standalone diagnostic tests or to modify surgical management. Independent prospective validation is required.