Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100730, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China.
World J Surg Oncol. 2023 Oct 26;21(1):337. doi: 10.1186/s12957-023-03225-0.
To investigate the prognostic significance of the systemic immune-inflammation index (SII) for patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) and develop nomogram models for predicting overall survival (OS), intravesical recurrence (IVR), and extra-urothelial recurrence (EUR).
We retrospectively studied the clinical and pathological features of 195 patients who underwent RNU for UTUC. All patients were randomly divided into a training cohort (99 cases) and a validation cohort (96 cases). The training cohort was used to develop nomogram models, and the models were validated by the validation cohort. The least absolute shrinkage and selection operator (LASSO) regression and Cox regression were performed to identify independent predictors. The concordance index (C-index), receiver operator characteristics (ROC) analysis, and calibration plot were used to evaluate the reliability of the models. The clinical utility compared with the pathological T stage was assessed using the net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).
SII was an independent risk factor in predicting OS and EUR. The C-index values of the nomogram predicting OS, IVR, and EUR were 0.675, 0.702, and 0.756 in the training cohort and 0.715, 0.756, and 0.713 in the validation cohort. A high level of SII was correlated with the invasion of the mucosa, muscle layer of the ureter, nerves, vessels, and fat tissues.
We developed nomogram models to predict the OS, IVR, and EUR of UTUC patients. The efficacy of these models was substantiated through internal validation, demonstrating favorable discrimination, calibration, and clinical utility. A high level of SII was associated with both worse OS and shorter EUR-free survival.
研究全身免疫炎症指数（SII）对接受根治性肾输尿管切除术（RNU）后上尿路上皮癌（UTUC）患者的预后意义，并建立预测总生存（OS）、膀胱内复发（IVR）和尿路上皮外复发（EUR）的列线图模型。
我们回顾性研究了 195 例接受 RNU 治疗 UTUC 的患者的临床和病理特征。所有患者均随机分为训练队列（99 例）和验证队列（96 例）。训练队列用于建立列线图模型，并通过验证队列验证模型。采用最小绝对值收缩和选择算子（LASSO）回归和 Cox 回归筛选独立预测因素。采用一致性指数（C 指数）、接受者操作特征（ROC）分析和校准图评估模型的可靠性。采用净重新分类指数（NRI）、综合判别改善（IDI）和决策曲线分析（DCA）评估与病理 T 分期相比的临床实用性。
SII 是预测 OS 和 EUR 的独立危险因素。预测 OS、IVR 和 EUR 的列线图模型在训练队列中的 C 指数值分别为 0.675、0.702 和 0.756，在验证队列中的 C 指数值分别为 0.715、0.756 和 0.713。高 SII 水平与黏膜、输尿管肌肉层、神经、血管和脂肪组织浸润相关。
我们建立了预测 UTUC 患者 OS、IVR 和 EUR 的列线图模型。内部验证证实了这些模型的疗效，具有良好的区分度、校准度和临床实用性。高 SII 水平与较差的 OS 和较短的 EUR 无复发生存时间相关。
