Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

• Published in: World journal of urology 2021-12, Vol.39 (12), p.4355-4361
• Main Authors: Katayama, Satoshi, Mori, Keiichiro, Pradere, Benjamin, Laukhtina, Ekaterina, Schuettfort, Victor M., Quhal, Fahad, Motlagh, Reza Sari, Mostafaei, Hadi, Grossmann, Nico C., Rajwa, Pawel, Moschini, Marco, Mathieu, Romain, Abufaraj, Mohammad, D’Andrea, David, Compérat, Eva, Haydter, Martin, Egawa, Shin, Nasu, Yasutomo, Shariat, Shahrokh F.
• Format: Article
• Language: English
• Subjects: Aged; Bladder cancer; Cancer; Decision making; Female; Humans; Inflammation; Inflammation - etiology; Invasiveness; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Nephrology; Oncology; Original; Original Article; Patients; Prediction models; Prognosis; Retrospective Studies; Risk Assessment; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - immunology; Urinary Bladder Neoplasms - pathology; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-021-03740-3

Purpose We assessed the prognostic value of systemic immune-inflammation index (SII) to refine risk stratification of the heterogeneous spectrum of patients with non-muscle-invasive bladder cancer (NMIBC) Methods In this multi-institutional cohort, preoperative blood-based SII was retrospectively assessed in 1117 patients with NMIBC who underwent transurethral resection of bladder (TURB) between 1996 and 2007. The optimal cut-off value of SII was determined as 580 using the best Youden index. Cox regression analyses were performed. The concordance index (C-index) and decision curve analysis (DCA) were used to assess the discrimination of the predictive models. Results Overall, 309 (28%) patients had high SII. On multivariable analyses, high SII was significantly associated with worse PFS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23–2.77; P  = 0.003) and CSS (HR 2.53; 95% CI 1.42–4.48; P  = 0.001). Subgroup analyses, according to the European Association of Urology guidelines, demonstrated the main prognostic impact of high SII, with regards to PFS (HR 3.39; 95%CI 1.57–7.31; P  = 0.002) and CSS (HR 4.93; 95% CI 1.70–14.3; P  = 0.005), in patients with intermediate-risk group; addition of SII to the standard predictive model improved its discrimination ability both on C-index (6% and 12%, respectively) and DCA. In exploratory intergroup analyses of patients with intermediate-risk, the improved discrimination ability was retained the prediction of PFS and CSS. Conclusion Preoperative SII seems to identify NMIBC patients who have a worse disease and prognosis. Such easily available and cheap standard biomarkers may help refine the decision-making process regarding adjuvant treatment in patients with intermediate-risk NMIBC.