Purpose: This retrospective study aimed to identify factors associated with postoperative cognitive dysfunction (POCD) in patients undergoing hepatectomy, with particular attention to liver disease-related characteristics and perioperative variables. A secondary aim was to develop a clinically applicable nomogram for individualized risk estimation in this population. Patients and Methods: A retrospective cohort study was conducted in 314 consecutive patients who underwent hepatectomy at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School between January 2023 and December 2024. Patients were included if they had complete clinical data and underwent preoperative and postoperative cognitive assessment. Exclusion criteria included preoperative cognitive impairment (Montreal Cognitive Assessment [MoCA] score < 26), preexisting neurological or psychiatric disorders, and in-hospital death within 72 h after surgery. POCD was defined as a decline of ≥3 points in the MoCA score from baseline to postoperative day 5. Clinical, surgical, nutritional, and perioperative variables were analyzed, and a nomogram was constructed based on the final multivariable logistic regression model. Results: The overall incidence of POCD was 27.4% (86/314). The final multivariable model included sarcopenia, preoperative hemoglobin < 120 g/L, Child–Pugh classification, alcohol consumption, operative duration, and pain score on postoperative day 1. The nomogram incorporating these variables showed good discriminative ability, with an area under the curve of 0.87 (95% CI: 0.83–0.92). Conclusions: In this retrospective cohort of patients undergoing hepatectomy, several perioperative clinical factors were associated with POCD. The proposed nomogram may serve as a practical tool for perioperative risk estimation and support more individualized management in higher-risk patients.

Background: Gemcitabine–cisplatin (GC) combined with a programmed death-ligand 1 (PD-L1) inhibitor has become an important first-line regimen for advanced intrahepatic cholangiocarcinoma (ICC). However, overall efficacy remains modest, and inter-patient heterogeneity in outcomes is substantial, highlighting the need for simple biomarkers for pretreatment risk stratification. The systemic immune-inflammation index (SII), derived from peripheral neutrophil, lymphocyte, and platelet counts, has been associated with prognosis in various malignancies, but its clinical relevance in advanced ICC treated with first-line GC plus PD-L1 inhibitor remains unclear. Aims: To evaluate the association of baseline SII with objective response and survival outcomes in patients with advanced ICC receiving first-line GC plus PD-L1 inhibitor. Methods: We retrospectively analyzed 193 consecutive patients with advanced ICC who received first-line GC plus a PD-L1 inhibitor at our center. Baseline clinicopathologic characteristics and laboratory parameters were collected, and SII was calculated as platelet count (×10⁹/L) × neutrophil count (×10⁹/L)/lymphocyte count (×10⁹/L). Receiver operating characteristic (ROC) analysis was performed to assess the discriminative ability of baseline SII for objective response and to determine an internally derived cut-off value. Patients were categorized into low- and high-SII groups accordingly. Logistic regression was used to identify factors associated with objective response rate (ORR). Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method and compared using the log-rank test. Multivariable Cox proportional hazards models were constructed to evaluate the independent prognostic significance of SII for PFS and OS. Results: Among the 193 patients included, 55 achieved complete or partial response and 138 had stable or progressive disease, yielding an ORR of 28.5%. Baseline SII showed good discrimination for objective response (AUC = 0.91), and the optimal cut-off value was 495.75. Patients in the low-SII group had a significantly higher ORR than those in the high-SII group (p < 0.001). Kaplan–Meier analysis demonstrated that both PFS and OS were longer in the low-SII group than in the high-SII group (median OS: 13.0 vs. 8.0 months, log-rank p < 0.001; median PFS: 8.5 vs. 6.0 months, p = 0.025). In multivariable Cox models adjusting for differentiation, CA19-9, tumor multiplicity, and distant metastasis, SII grouping remained independently associated with PFS and OS, and distant metastasis was consistently associated with increased risks of progression and death. Conclusions: Baseline SII is a readily available prognostic biomarker associated with objective response and survival in patients with advanced ICC treated with first-line GC plus PD-L1 inhibitor. Given the retrospective single-center design, the absence of a non-immunotherapy comparator cohort, and internal cut-off derivation, these findings should be interpreted as hypothesis-generating and warrant external validation.