Ni Jinliang, Wang Keyi, Zhang Houliang, Xie Jinbo, Xie Jun, Tian Changxiu, Zhang Yifan, Li Weiyi, Su Bin, Liang Chaozhao, Song Xinran, Peng Bo
Department of Urology, Shanghai Tenth People's Hospital, Tongi University, Shanghai, China.
Shanghai Clinical College, Anhui Medical University, Hefei, China.
Front Oncol. 2021 Aug 16;11:722151. doi: 10.3389/fonc.2021.722151. eCollection 2021.
The aim of this study was to evaluate the prognostic significance of the systemic inflammatory response index (SIRI) in patients with bladder cancer (BCa) treated with radical cystectomy (RC) and develop a survival predictive model through establishing a nomogram.
A total of 203 BCa patients who underwent RC were included in this study. The relationship between the SIRI and overall survival (OS), disease-free survival (DFS), and clinicopathological features were evaluated. Cox regression analysis was performed to investigate the effect of the factors on the OS and DFS. The results were applied in the establishment of a nomogram. Receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves were performed to assess the predictive performance and accuracy of the nomogram, respectively.
According to the classification of the SIRI, 81 patients (39.9%) were assigned to SIRI grade 1, 94 patients (46.3%) to SIRI grade 2, and the remaining 28 patients (13.8%) to SIRI grade 3. Multivariate Cox regression revealed that a higher SIRI grade was significantly associated with a poor prognosis and served as an independent prognostic factor for the OS [Grade 2 Grade 1, odds ratio = 2.54, 95% confidence interval (CI),1.39-4.64, P = 0.002; Grade 3 Grade 1, odds ratio = 4.79, 95%CI: 2.41-9.50, P < 0.001] and DFS [Grade 2 Grade 1, odds ratio = 2.19, 95% CI, 1.12-4.31, P = 0.023; Grade 3 Grade 2, odds ratio = 3.36, 95%CI, 1.53-7.35, P = 0.002]. The ROC and DCA analysis indicated that the nomogram based on the SIRI contained a better predictive performance compared with the TNM stage (AUC = 0.750 and 0.791; all P < 0.05). The ROC analysis showed that nomograms can better predict the 3- and 5-year OS and DFS. The calibration curves exhibited a significant agreement between the nomogram and the actual observation.
SIRI as a novel independent prognostic index and potential prognostic biomarker can effectively improve the traditional clinicopathological analysis and optimize individualized clinical treatments for BCa patients after RC.
本研究旨在评估全身炎症反应指数（SIRI）在接受根治性膀胱切除术（RC）的膀胱癌（BCa）患者中的预后意义，并通过建立列线图开发一种生存预测模型。
本研究共纳入203例行RC的BCa患者。评估SIRI与总生存期（OS）、无病生存期（DFS）及临床病理特征之间的关系。进行Cox回归分析以研究各因素对OS和DFS的影响。将结果应用于列线图的建立。分别绘制受试者工作特征（ROC）曲线、决策曲线分析（DCA）曲线和校准曲线，以评估列线图的预测性能和准确性。
根据SIRI分类，81例患者（39.9%）被归为SIRI 1级，94例患者（46.3%）为SIRI 2级，其余28例患者（13.8%）为SIRI 3级。多因素Cox回归显示，较高的SIRI分级与预后不良显著相关，是OS的独立预后因素[2级 vs 1级，比值比=2.54，95%置信区间（CI），1.39 - 4.64，P = 0.002；3级 vs 1级，比值比=4.79，95%CI：2.41 - 9.50，P < 0.001]和DFS的独立预后因素[2级 vs 1级，比值比=2.19，95%CI，1.12 - 4.31，P = 0.023；3级 vs 2级，比值比=3.36，95%CI，1.53 - 7.35，P = 0.002]。ROC和DCA分析表明，基于SIRI的列线图比TNM分期具有更好的预测性能（AUC = 0.750和0.791；所有P < 0.05）。ROC分析表明，列线图能更好地预测3年和5年OS及DFS。校准曲线显示列线图与实际观察结果具有显著一致性。
SIRI作为一种新型独立预后指标和潜在预后生物标志物，可有效改善传统临床病理分析，优化RC术后BCa患者的个体化临床治疗。
