TY - JOUR
T1 - Impact of preoperative systemic immune-inflammation Index on oncologic outcomes in bladder cancer patients treated with radical cystectomy
AU - Grossmann, Nico C.
AU - Schuettfort, Victor M.
AU - Pradere, Benjamin
AU - Rajwa, Pawel
AU - Quhal, Fahad
AU - Mostafaei, Hadi
AU - Laukhtina, Ekaterina
AU - Mori, Keiichiro
AU - Motlagh, Reza S.
AU - Aydh, Abdulmajeed
AU - Katayama, Satoshi
AU - Moschini, Marco
AU - Fankhauser, Christian D.
AU - Hermanns, Thomas
AU - Abufaraj, Mohammad
AU - Mun, Dong Ho
AU - Zimmermann, Kristin
AU - Fajkovic, Harun
AU - Haydter, Martin
AU - Shariat, Shahrokh F.
N1 - Funding Information:
Nico C. Grossmann is supported by the Zurich Cancer League. Victor Schuettfort, and Ekaterina Laukhtina are supported by the EUSP Scholarship of the European Association of Urology (EAU).
Publisher Copyright:
© 2021 The Authors
PY - 2022/3
Y1 - 2022/3
N2 - Purpose: To investigate the predictive and prognostic value of the preoperative systemic immune-inflammation index (SII) in patients undergoing radical cystectomy (RC) for clinically non-metastatic urothelial cancer of the bladder (UCB). Methods: Overall, 4,335 patients were included, and the cohort was stratified in two groups according to SII using an optimal cut-off determined by the Youden index. Uni- and multivariable logistic and Cox regression analyses were performed, and the discriminatory ability by adding SII to a reference model based on available clinicopathologic variables was assessed by area under receiver operating characteristics curves (AUC) and concordance-indices. The additional clinical net-benefit was assessed using decision curve analysis (DCA). Results: High SII was observed in 1879 (43%) patients. On multivariable preoperative logistic regression, high SII was associated with lymph node involvement (LNI; P = 0.004), pT3/4 disease (P <0.001), and non-organ confined disease (NOCD; P <0.001) with improvement of AUCs for predicting LNI (P = 0.01) and pT3/4 disease (P = 0.01). On multivariable Cox regression including preoperative available clinicopathologic values, high SII was associated with recurrence-free survival (P = 0.028), cancer-specific survival (P = 0.005), and overall survival (P = 0.006), without improvement of concordance-indices. On DCAs, the inclusion of SII did not meaningfully improve the net-benefit for clinical decision-making in all models. Conclusion: High preoperative SII is independently associated with pathologic features of aggressive disease and worse survival outcomes. However, it did not improve the discriminatory margin of a prediction model beyond established clinicopathologic features and failed to add clinical benefit for decision making. The implementation of SII as a part of a panel of biomarkers in future studies might improve decision-making.
AB - Purpose: To investigate the predictive and prognostic value of the preoperative systemic immune-inflammation index (SII) in patients undergoing radical cystectomy (RC) for clinically non-metastatic urothelial cancer of the bladder (UCB). Methods: Overall, 4,335 patients were included, and the cohort was stratified in two groups according to SII using an optimal cut-off determined by the Youden index. Uni- and multivariable logistic and Cox regression analyses were performed, and the discriminatory ability by adding SII to a reference model based on available clinicopathologic variables was assessed by area under receiver operating characteristics curves (AUC) and concordance-indices. The additional clinical net-benefit was assessed using decision curve analysis (DCA). Results: High SII was observed in 1879 (43%) patients. On multivariable preoperative logistic regression, high SII was associated with lymph node involvement (LNI; P = 0.004), pT3/4 disease (P <0.001), and non-organ confined disease (NOCD; P <0.001) with improvement of AUCs for predicting LNI (P = 0.01) and pT3/4 disease (P = 0.01). On multivariable Cox regression including preoperative available clinicopathologic values, high SII was associated with recurrence-free survival (P = 0.028), cancer-specific survival (P = 0.005), and overall survival (P = 0.006), without improvement of concordance-indices. On DCAs, the inclusion of SII did not meaningfully improve the net-benefit for clinical decision-making in all models. Conclusion: High preoperative SII is independently associated with pathologic features of aggressive disease and worse survival outcomes. However, it did not improve the discriminatory margin of a prediction model beyond established clinicopathologic features and failed to add clinical benefit for decision making. The implementation of SII as a part of a panel of biomarkers in future studies might improve decision-making.
KW - Biomarkers
KW - Inflammation, Prognosis
KW - SII
KW - Transitional cell carcinoma
KW - Urinary bladder neoplasms
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U2 - 10.1016/j.urolonc.2021.10.006
DO - 10.1016/j.urolonc.2021.10.006
M3 - Article
C2 - 34810077
AN - SCOPUS:85125136857
SN - 1078-1439
VL - 40
SP - 106.e11-106.e19
JO - Seminars in Urology
JF - Seminars in Urology
IS - 3
ER -
