全身综合炎症评分（SCIS）：一种预测高危非肌层浸润性尿路上皮膀胱癌患者肿瘤学结局的新评分。
Systemic combining inflammatory score (SCIS): a new score for prediction of oncologic outcomes in patients with high-risk non-muscle-invasive urothelial bladder cancer.
作者信息
Ferro Matteo, Di Mauro Marina, Cimino Sebastiano, Morgia Giuseppe, Lucarelli Giuseppe, Abu Farhan Abdal Rahman, Vartolomei Mihai Dorin, Porreca Angelo, Cantiello Francesco, Damiano Rocco, Busetto Gian Maria, Del Giudice Francesco, Hurle Rodolfo, Perdonà Sisto, Borghesi Marco, Bove Pierluigi, Autorino Riccardo, Crisan Nicolae, Marchioni Michele, Schips Luigi, Soria Francesco, Mari Andrea, Minervini Andrea, Veccia Alessandro, Battaglia Michele, Terracciano Daniela, Musi Gennaro, Cordima Giovanni, Muto Matteo, Mirone Vincenzo, de Cobelli Ottavio, Russo Giorgio Ivan
机构信息
Division of Urology, European Institute of Oncology, Milan, Italy.
Urology Section, Department of Surgery, University of Catania, Catania, Italy.
出版信息
Transl Androl Urol. 2021 Feb;10(2):626-635. doi: 10.21037/tau-20-1272.
BACKGROUND
An accurate and early diagnosis of bladder cancer (BC) is essential to offer patients the most appropriate treatment and the highest cure rate. For this reason, patients need to be best stratified by class and risk factors. We aimed to develop a score able to better predict cancer outcomes, using serum variables of inflammation.
METHODS
A total of 1,510 high-risk non-muscle invasive bladder cancer (NMIBC) patients were included in this retrospective observational study. Patients with pathologically proven T1 HG/G3 at first TURBT were included. Systemic combined inflammatory score (SCIS) was calculated according to systemic inflammatory markers (SIM), modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) dichotomized (final score from 0 to 3).
RESULTS
After 48 months of follow-up (IQR 40.0-73.0), 727 patients recurred (48.1%), 485 progressed (32.1%), 81 died for cancer (7.0%), and 163 died for overall causes (10.8%). Overall, 231 (15.3%) patients had concomitant Cis, 669 (44.3%) patients had multifocal pathology, 967 (64.1%) patients had tumor size >3 cm. Overall, 357 (23.6%) patients received immediate-intravesical therapy, 1,356 (89.8%) received adjuvant intravesical therapy, of which 1,382 (91.5%) received BCG, 266 (17.6%) patients received mitomycin C, 4 (0.5%) patients received others intravesical therapy. Higher SCIS was independently predictive of recurrence (hazard ratio HR 1.5, 1.3 and 2.2) and cancer specific mortality for SCIS 0 and 3 (HR: 1.61 and 2.3), and overall mortality for SCIS 0 and 3 (HR: 2.4 and 3.2). Conversely, SCIS was not associated with a higher probability of progression.
CONCLUSIONS
The inclusion of the SCIS in clinical practice is simple to apply and can help improve the prediction of cancer outcomes. It can identify patients with high-grade BC who are more likely to experience disease mortality.
背景
膀胱癌（BC）的准确早期诊断对于为患者提供最合适的治疗和最高的治愈率至关重要。因此，需要根据类别和风险因素对患者进行最佳分层。我们旨在利用炎症血清变量开发一种能够更好地预测癌症预后的评分系统。
方法
本回顾性观察研究共纳入1510例高危非肌层浸润性膀胱癌（NMIBC）患者。纳入初次经尿道膀胱肿瘤切除术（TURBT）病理证实为T1 HG/G3的患者。根据全身炎症标志物（SIM）、改良格拉斯哥预后评分（mGPS）和二分法的预后营养指数（PNI）计算全身综合炎症评分（SCIS）（最终评分从0到3）。
结果
经过48个月的随访（四分位间距40.0 - 73.0），727例患者复发（48.1%），485例进展（32.1%），81例死于癌症（7.0%），163例死于其他原因（10.8%）。总体而言，231例（15.3%）患者同时患有原位癌，669例（44.3%）患者有多灶性病变，967例（64.1%）患者肿瘤大小>3 cm。总体而言，357例（23.6%）患者接受了即刻膀胱内治疗，1356例（89.8%）接受了辅助膀胱内治疗，其中1382例（91.5%）接受了卡介苗（BCG）治疗，266例（17.6%）患者接受了丝裂霉素C治疗，4例（0.5%）患者接受了其他膀胱内治疗。较高的SCIS独立预测复发（风险比HR分别为1.5、1.3和2.2）以及SCIS为0和3时的癌症特异性死亡率（HR：1.61和2.3），以及SCIS为0和3时的总体死亡率（HR：2.4和3.2）。相反，SCIS与进展的较高概率无关。
结论
在临床实践中纳入SCIS易于应用，有助于改善癌症预后的预测。它可以识别出更有可能经历疾病死亡的高级别膀胱癌患者。
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