Predictive value of peripheral blood systemic immune-inflammation index and blood cell ratio for gastrointestinal polyp burden in patients with Peutz-Jeghers syndrome

doi:10.5306/wjco.123640

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Jul 24, 2026; 17(7): 123640
Published online Jul 24, 2026. doi: 10.5306/wjco.123640

Predictive value of peripheral blood systemic immune-inflammation index and blood cell ratio for gastrointestinal polyp burden in patients with Peutz-Jeghers syndrome

Zu-Xin Xu, Jing Liu, Peng-Fei Yu, Zhi-Wei Dong, Dan Jiang, Guo-Li Gu

Zu-Xin Xu, Department of Gastrointestinal Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China

Jing Liu, Peng-Fei Yu, Zhi-Wei Dong, Guo-Li Gu, Department of General Surgery, Air Force Medical Center, Chinese PLA, Beijing 100142, China

Dan Jiang, Department of Anesthesiology, Air Force Medical Center, Chinese PLA, Beijing 100142, China

Co-first authors: Zu-Xin Xu and Jing Liu.

Co-corresponding authors: Dan Jiang and Guo-Li Gu.

Author contributions: Jiang D and Gu GL designed the research; Xu ZX, Liu J, Yu PF and Dong ZW collected data, analyzed and interpreted data, and written the manuscript. Jiang D and Gu GL provided the material support, revised the manuscript, they are the co-corresponding authors of this manuscript. All authors approved the final manuscript. Xu ZX and Liu J contributed equally to this study; they are the co-first authors of this manuscript. The study design and project application were co-directed by Jiang D and Gu GL, the study protocol was approved by the Hospital Ethics Committee and the Institutional Review Board. Both investigators, as co-principal investigators of the research group, played equally pivotal and core roles in the conceptualization of the topic, the formulation of the study protocol, and the final preparation of the manuscript. Given that Jiang D and Gu GL have made equally significant and irreplaceable contributions to this research, a single corresponding author would inadequately reflect the leading roles that both have played in terms of intellectual input and resource provision. The designation of co-corresponding authorship therefore serves as a fair acknowledgment of their shared academic leadership. Finally, it ensures long-term accountability, as one author may retire or move, leaving the other to handle post-publication queries. However, the last-named author is still conventionally seen as the senior principal investigator.

AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center, No. 2025-95-PJ01.

Informed consent statement: Consent was obtained from patients or their relatives for publication of this report.

Conflict-of-interest statement: The authors declare no conflict of interests for this article.

Data sharing statement: No additional data are available.

Corresponding author: Guo-Li Gu, MD, Chief, Director, Department of General Surgery, Air Force Medical Center, Chinese PLA, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. kzggl@163.com

Received: June 2, 2026
Revised: June 28, 2026
Accepted: July 14, 2026
Published online: July 24, 2026
Processing time: 51 Days and 19.3 Hours

Abstract

BACKGROUND

Peutz-Jeghers syndrome (PJS) features gastrointestinal hamartomatous polyps prone to intussusception, obstruction, bleeding, and malignancy. No effective predictors exist for polyp progression. Peripheral blood systemic immune-inflammation index (SII) and blood cell ratios (BCR) correlate with cancer prognosis, but their relationship with PJS polyp size (diameter)/burden (number) remains unknown. This study aims to evaluate the value of this simple and non-invasive method in predicting the polyp burden of PJS.

AIM

To investigate the correlations of SII and peripheral BCR with clinicopathological features in patients with PJS, and to evaluate their predictive value for gastrointestinal polyp burden in PJS.

METHODS

Patients with PJS who met the inclusion and exclusion criteria and were treated at the Air Force Medical Center, Chinese People’s Liberation Army from January 1, 2020, to December 31, 2025, were enrolled in this study. Their clinicopathological data were retrospectively analyzed. Spearman correlation analysis was used to assess the correlations of gastrointestinal polyp size and number with SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). The predictive performance was evaluated using receiver operating characteristic curves.

RESULTS

A total of 636 PJS patients were enrolled in this study. Polyp burden varied across different gastrointestinal segments. SII, NLR, PLR, and MLR could predict the presence of small bowel polyps in PJS patients and were positively correlated with the number of small bowel polyps (r = 0.206, P < 0.001; r = 0.133, P = 0.001; r = 0.128, P = 0.001; r = 0.090, P= 0.024, respectively). MLR was identified as an independent risk factor for malignancy in PJS patients [odds ratio (OR) = 12.186, P = 0.010]. The cumulative risks of cancer in PJS patients at ages 40 years, 50 years, and 60 years were 23.6%, 50.8%, and 66.4%, respectively. The combined model of SII, NLR, PLR, and MLR yielded area under the curve values of 0.779 and 0.774 for predicting large polyps (diameter ≥ 25 mm) and multiple polyps (number ≥ 10), respectively. Multivariate logistic regression analysis showed that PLR (OR = 1.004, 95% confidence interval: 1.001-1.008, P = 0.011) was an independent risk factor for multiple small bowel polyps in PJS patients.

CONCLUSION

The combination of SII, NLR, PLR, and MLR can predict small bowel polyp burden in PJS patients, and holds promise as a non-invasive and cost-effective risk stratification biomarker to facilitate individualized surveillance and early risk intervention in PJS patients.

Keywords: Peutz-Jeghers syndrome; Polyps; Blood cell ratios; Systemic immune-inflammation index

Core Tip: This study aimed to analyze the correlations of the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) with clinicopathological features in patients with Peutz-Jeghers syndrome (PJS). Based on correlation analysis and multivariable logistic regression analysis, we constructed and validated a predictive model incorporating SII, NLR, PLR, and MLR to estimate the size and number of small intestinal polyps in PJS patients. This model holds promise as a non-invasive and cost-effective risk stratification marker, thereby facilitating individualized monitoring and early risk intervention.