Preoperative Inflammatory Markers in Relation to the Malignant Potential of Cartilaginous Tumors: A Retrospective Cohort Study

Background: The definitive diagnosis of cartilaginous tumors remains challenging because imaging and biopsy findings may not reliably distinguish low-grade from high-grade lesions. Consequently, the final diagnosis is often established only after surgical excision and histopathological examination. Inflammatory biomarkers derived from routine peripheral blood tests have emerged as potential adjunctive tools for tumor characterization, but their role in cartilaginous tumors remains unclear. Questions/Purposes: (1) Are preoperative inflammatory markers different between low-grade and high-grade cartilaginous tumors? (2) Which inflammatory markers are associated with high-grade (versus low-grade) cartilaginous tumors? (3) What is the diagnostic performance of the pan-immune inflammation value (PIV) in predicting high-grade cartilaginous tumors? Patients and Methods: We retrospectively reviewed 67 patients who underwent surgery for cartilaginous tumors between January 2022 and July 2025 and received definitive histopathological diagnoses. Patients were divided into two groups according to tumor grade. Group A consisted of enchondroma (n = 9), atypical cartilaginous tumor (ACT) (n = 13), and Grade 1 chondrosarcoma (n = 14), whereas Group B consisted of Grade 2 (n = 19) and Grade 3 chondrosarcoma (n = 12). Preoperative peripheral blood inflammatory markers, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), mean platelet volume (MPV), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV), were compared between groups. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of significant biomarkers. Results: Baseline demographic and clinical characteristics were comparable between groups. Patients with high-grade chondrosarcoma (Group B) demonstrated higher CRP (6.35 ± 5.25 versus 4.02 ± 3.33; p = 0.030), PLR (198.08 ± 98.83 versus 139.11 ± 73.76; p = 0.016), SII (728.33 ± 177.26 versus 526.50 ± 126.17; p = 0.001), SIRI (2.01 ± 0.72 versus 1.40 ± 0.62; p = 0.001), and PIV (629.68 ± 125.19 versus 295.00 ± 111.48; p = 0.001) compared with Group A. ROC analysis showed that PIV had the highest diagnostic accuracy, with a cutoff value greater than 461.5 yielding a sensitivity of 96.8% and a specificity of 97.2% for identifying high-grade malignancy (p < 0.001). Conclusions: Preoperative inflammatory markers, particularly SII, SIRI, and PIV, were associated with high-grade cartilaginous tumors; differences in CRP and PLR did not survive correction for multiple comparisons. Among these markers, PIV demonstrated excellent discriminatory ability for distinguishing high-grade from low-grade cartilaginous tumors. These findings suggest that PIV may serve as a readily available and low-cost adjunctive biomarker in the preoperative evaluation of cartilaginous tumors. Further prospective studies are warranted to validate its clinical utility and determine its role alongside established radiological and histopathological assessment methods. Level of Evidence: Level III, diagnostic study (retrospective comparative cohort study).