Cancer related malnutrition is extremely common and it has s effect on quality of life, overall survival, disease free survival and recurrence. The patient’s nutritional status has significant impact on immune system, inflammatory response and wound healing process^.1 Systemic inflammation is linked to poor prognosis in cancer patients 

Gallbladder cancer (GBC) remains an aggressive malignancy, often discovered late, and with limited prognostic tools beyond standard histopathology. 

In recent years, simple blood-based inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin-to-globulin ratio (AGR), and the systemic immune-inflammation index (SII), have shown potential in anticipating tumour behaviour, postoperative complications, and survival in several cancers.

Albumin is an important marker that reflects nutritional status of a person. It is also an antioxidant, stabilizes cell growth and maintains homeostasis of sex hormones. Many recent studies have shown it to be an independent predictor of overall survival .^{1 ,2}

Low levels are seen in chronic inflammation which weakens the defense system and ultimately body becomes susceptible to infection and cytokine induced immune suppression. This eventually leads to recurrence of disease and decreased overall survival.^1-4

A decreased albumin and high globulin level reflects chronic inflammation (total protein- albumin) and this inflammatory process leads to release of pro inflammatory cytokines which further promotes growth and proliferation of tumor cells.Systemic inflammatory responses also suppresses liver function resulting in decreased albumin synthesis. Many recent studied have shown that increased systemic inflammatory response preoperatively leads to poor   outcome.⁵

Albumin globulin ratio (AGR) which is a combination of albumin and non-albumin, is a better marker than albumin alone because it reflects both malnutrition and inflammation. ^4,6,7 Moreover, it is not affected by fluid status like albumin. 

AGR is identified as a simple and useful predictive biomarker for evaluation of post-operative outcomes and survival in several cancers. 

Higher neutrophil to lymphocyte ratio (NLR) and platelets to lymphocyte ratio (PLR) values, in particular, have been repeatedly linked with poorer outcomes, whereas a low AGR may reflect both malnutrition and systemic inflammation, compounding risk. 

Tracking perioperative changes in these markers could offer a dynamic snapshot of the immune response and surgical stress, perhaps allowing earlier intervention. This study will explore their diagnostic and prognostic role in a surgical GBC cohort

Impact of AGR, NLR, PLR and APRI on postoperative outcomes in terms of morbidity and mortality is not studied much in gall bladder cancers, we therefore want to study the impact of these in gall bladder cancers in perioperative period.