Department of Urology, Bozyaka Training and Research Hospital, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey.
Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey.
Urol Int. 2023;107(6):617-623. doi: 10.1159/000528740. Epub 2023 Feb 21.
In this study, we aimed to explore using the predictive role of systemic immune inflammation index (SII) for responses of intravesical Bacillus Calmette-Guérin (BCG) therapy in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC).
From 9 centers, we reviewed the data of patients treated for intermediate- and high-risk NMIBC between 2011 and 2021. All patients enrolled in the study presented with T1 and/or high-grade tumors on initial TURB had undergone re-TURB within 4-6 weeks after initial TURB and had received at least a 6-week course of intravesical BCG induction. SII was calculated with the formula SII = (P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. In patients with intermediate- and high-risk NMIBC, the clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices. These included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-neutrophil ratio (PNR), and platelet-to-lymphocyte ratio (PLR).
A total of 269 patients were enrolled in the study. Median follow-up time was 39 months. Disease recurrence and progression were observed in 71 (26.4%) and 19 (7.1%) patients, respectively. For groups with and without disease recurrence in terms of NLR, PLR, PNR, and SII calculated prior to intravesical BCG treatment, no statistically significant differences were observed (p = 0.470, p = 0.247, p = 0.495, and p = 0.243, respectively). Moreover, there were also no statistically significant differences between the groups with and without disease progression in terms of NLR, PLR, PNR, and SII (p = 0.504, p = 0.165, p = 0.410, and p = 0.242, respectively). SII did not show any statistically significant difference between early (<6 months) and late (≥6 months) recurrence (p = 0.492) and progression groups (p = 0.216).
For patients with intermediate- and high-risk NMIBC, serum SII levels do not present as an appropriate biomarker for the prediction of disease recurrence and progression following intravesical BCG therapy. A possible explanation for the failure of SII to predict BCG response may be found in the impact of Turkey's nationwide tuberculosis vaccination program.
本研究旨在探讨系统免疫炎症指数（SII）对卡介苗膀胱内治疗中高危非肌肉浸润性膀胱癌（NMIBC）患者反应的预测作用。
我们从 9 个中心回顾了 2011 年至 2021 年间接受中高危 NMIBC 治疗的患者数据。所有入组患者均为初始 TURB 时表现为 T1 和/或高级别肿瘤，初始 TURB 后 4-6 周内行再次 TURB，并接受至少 6 周的膀胱内卡介苗诱导治疗。SII 通过公式 SII =（P × N）/L 计算，其中 P、N 和 L 分别指外周血小板、中性粒细胞和淋巴细胞计数。在中高危 NMIBC 患者中，评估了临床病理特征和随访数据，以比较 SII 与其他基于全身炎症的预后指标。这些指标包括中性粒细胞与淋巴细胞比值（NLR）、血小板与中性粒细胞比值（PNR）和血小板与淋巴细胞比值（PLR）。
共有 269 名患者入组本研究。中位随访时间为 39 个月。71 例（26.4%）和 19 例（7.1%）患者分别出现疾病复发和进展。对于 NLR、PLR、PNR 和 SII 在膀胱内卡介苗治疗前计算的复发和无复发组，各组之间无统计学差异（p=0.470、p=0.247、p=0.495 和 p=0.243）。此外，疾病进展和无进展组之间 NLR、PLR、PNR 和 SII 也无统计学差异（p=0.504、p=0.165、p=0.410 和 p=0.242）。SII 在 6 个月内（<6 个月）和 6 个月后（≥6 个月）复发（p=0.492）和进展组之间无统计学差异（p=0.216）。
对于中高危 NMIBC 患者，血清 SII 水平不能作为预测膀胱内卡介苗治疗后疾病复发和进展的合适生物标志物。SII 未能预测 BCG 反应的一个可能解释可能是土耳其全国结核病疫苗接种计划的影响。
