Gu Yufeng, Fu Yao, Pan Xin, Zhou Yulin, Ji Changwei, Zhao Tangliang, Miao He, Lv Huichen, Da Jianping, Ge Jingping, Wang Linhui, Qu Le, Ge Silun, Guo Hongqian, Zhou Wenquan
Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China.
Department of Pathology, Drum Tower Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China.
Front Oncol. 2023 Jan 26;13:1117595. doi: 10.3389/fonc.2023.1117595. eCollection 2023.
This study aims to determine the prognostic value of SII for non-metastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). We retrospectively collected and analyzed 328 non-metastatic ccRCC patients with VTT who underwent radical nephrectomy and thrombectomy from 3 tertiary centers in China between 2011 to 2021. Kaplan-Meier analyses and Cox proportional hazard analyses were used to determine its prognostic value for overall survival (OS) and disease free survival (DFS). The Harrell concordance index (C-index), receiver operating characteristic curve (ROC) analysis, and decision curve analysis (DCA) were used to evaluate its role in the improvement of prognostic accuracy of the existing models. Nomogram models containing the SII were then developed and evaluated by R. Patients were divided into low-SII and high-SII groups based on the SII optimal cut-off value 912 calculated by the Youden index in all patients. Higher SII was correlated with more symptoms, longer surgical time, higher WHO/ISUP grade, and longer tumor diameter. Kaplan-Meier analyses revealed significant differences in OS and DFS between two groups. Multivariate analyses revealed that SII was an independent prognostic factor for OS (HR:2.220, p=0.002) and DFS (HR:1.846, p=0.002). Compared with other indicators, SII had a superior accuracy (c-index=0.630 for OS and 0.595 for DFS). It also improved the performance of models for predicting OS and DFS (all p <0.01). Based on the results of LASSO Cox regression analysis, we constructed a nomogram to predict OS and it performed well on both the training cohort (AUC=0.805) and the validation cohort (AUC=0.795). Risk stratification based on nomogram can distinguish patients with different risks (all p <0.001). Preoperative SII is an independent predictive factor for OS and DFS of non-metastatic ccRCC patients with VTT. It can be used to improve the performance of current risk models.
本研究旨在确定全身免疫炎症指数（SII）对非转移性透明细胞肾细胞癌（ccRCC）合并静脉瘤栓（VTT）患者的预后价值。我们回顾性收集并分析了2011年至2021年间在中国3家三级中心接受根治性肾切除术和瘤栓切除术的328例非转移性ccRCC合并VTT患者。采用Kaplan-Meier分析和Cox比例风险分析来确定其对总生存期（OS）和无病生存期（DFS）的预后价值。使用Harrell一致性指数（C指数）、受试者工作特征曲线（ROC）分析和决策曲线分析（DCA）来评估其在提高现有模型预后准确性方面的作用。然后开发了包含SII的列线图模型，并通过R进行评估。根据所有患者中由约登指数计算出的SII最佳截断值912，将患者分为低SII组和高SII组。较高的SII与更多症状、更长手术时间、更高的WHO/ISUP分级以及更长的肿瘤直径相关。Kaplan-Meier分析显示两组之间的OS和DFS存在显著差异。多因素分析显示SII是OS（风险比：2.220，p=0.002）和DFS（风险比：1.846，p=0.002）的独立预后因素。与其他指标相比，SII具有更高的准确性（OS的C指数=0.630，DFS的C指数=0.595）。它还改善了预测OS和DFS的模型性能（所有p<0.01）。基于LASSO Cox回归分析结果，我们构建了一个预测OS的列线图，其在训练队列（AUC=0.805）和验证队列（AUC=0.795）中表现良好。基于列线图的风险分层可以区分不同风险的患者（所有p<0.001）。术前SII是非转移性ccRCC合并VTT患者OS和DFS的独立预测因素。它可用于改善当前风险模型的性能。
