术前全身免疫炎症指数对接受根治性膀胱切除术的膀胱癌患者肿瘤学结局的影响。
Impact of preoperative systemic immune-inflammation Index on oncologic outcomes in bladder cancer patients treated with radical cystectomy.
作者信息
Grossmann Nico C, Schuettfort Victor M, Pradere Benjamin, Rajwa Pawel, Quhal Fahad, Mostafaei Hadi, Laukhtina Ekaterina, Mori Keiichiro, Motlagh Reza S, Aydh Abdulmajeed, Katayama Satoshi, Moschini Marco, Fankhauser Christian D, Hermanns Thomas, Abufaraj Mohammad, Mun Dong-Ho, Zimmermann Kristin, Fajkovic Harun, Haydter Martin, Shariat Shahrokh F
机构信息
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Zurich, Zurich, Switzerland.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Urol Oncol. 2022 Mar;40(3):106.e11-106.e19. doi: 10.1016/j.urolonc.2021.10.006. Epub 2021 Nov 20.
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.
目的
探讨术前全身免疫炎症指数（SII）对临床无转移的膀胱尿路上皮癌（UCB）患者行根治性膀胱切除术（RC）的预测和预后价值。
方法
共纳入4335例患者，根据SII使用约登指数确定的最佳临界值将队列分为两组。进行单变量和多变量逻辑回归及Cox回归分析，并通过受试者工作特征曲线下面积（AUC）和一致性指数评估将SII添加到基于可用临床病理变量的参考模型中的鉴别能力。使用决策曲线分析（DCA）评估额外的临床净效益。
结果
1879例（43%）患者SII较高。在多变量术前逻辑回归中，高SII与淋巴结受累（LNI；P = 0.00）、pT3/4期疾病（P < 0.001）和非器官局限性疾病（NOCD；P < 0.001）相关，预测LNI（P = 0.01）和pT3/4期疾病（P = 0.01）的AUC有所改善。在包括术前可用临床病理值的多变量Cox回归中，高SII与无复发生存（P = 0.028）、癌症特异性生存（P = 0.005）和总生存（P = 0.006）相关，一致性指数无改善。在DCA中，在所有模型中纳入SII并未显著改善临床决策的净效益。
结论
术前高SII与侵袭性疾病的病理特征和较差的生存结果独立相关。然而，它并未超出既定的临床病理特征改善预测模型的鉴别幅度，也未为决策增加临床益处。在未来研究中将SII作为生物标志物组合的一部分可能会改善决策。
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