MP66-13 THE PROGNOSTIC ROLE OF THE PREOPERATIVE SYSTEMIC IMMUNE-INFLAMMATION INDEX IN PATIENTS TREATED WITH RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Basic Research & Pathophysiology III (MP66)1 Sep 2021MP66-13 THE PROGNOSTIC ROLE OF THE PREOPERATIVE SYSTEMIC IMMUNE-INFLAMMATION INDEX IN PATIENTS TREATED WITH RADICAL CYSTECTOMY Nico C. Grossmann, Victor M. Schuettfort, Pawel Rajwa, Fahad Quhal, Hadi Mostafaei, Ekaterina Laukhtina, Keiichiro Mori, Reza S. Motlagh, Abdulmajeed Aydh, Satoshi Katayama, Benjamin Pradere, Marco Moschini, Mohammad Abufaraj, Dong-Ho Mun, Kristin Zimmermann, and Shahrokh F. Shariat Nico C. GrossmannNico C. Grossmann More articles by this author , Victor M. SchuettfortVictor M. Schuettfort More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Hadi MostafaeiHadi Mostafaei More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Reza S. MotlaghReza S. Motlagh More articles by this author , Abdulmajeed AydhAbdulmajeed Aydh More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Mohammad AbufarajMohammad Abufaraj More articles by this author , Dong-Ho MunDong-Ho Mun More articles by this author , Kristin ZimmermannKristin Zimmermann More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002106.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The heterogeneous behavior of bladder cancer (BC) demands for biomarkers (BM) with sufficient prognostic and predictive value. The preoperative systemic immune-inflammation index (SII) in patients who underwent radical cystectomy (RC) for BC was identified as an independent prognostic factor for worse survival outcomes in previous small-scale, single-center studies. The aim of this study was to validate these findings in a large, multinational cohort. METHODS: This multicenter, retrospective study included 4335 patients who were treated with RC for BC. The cohort was stratified in two groups by preoperative SII using optimal cut-off determined by the Youden index. Uni- and multivariable logistic and Cox regression analyses were performed, and the discriminatory ability of the models was assessed by area under receiver operating characteristics curves (AUC) and concordance-indices (c-index). The additional clinical net-benefit was assessed using the decision curve analysis (DCA). RESULTS: A high preoperative SII was observed in 1879 patients. The median follow-up was 42 months (IQR 18 - 85). On multivariable preoperative logistic regression, high SII was an independent predictor of lymph node metastasis (LNM; OR 1.23, 95% CI 1.07-1.42, p=0.004), pT3/4 disease (OR 1.55, 95% CI 1.36-1.77, p<0.001) and non-organ confined disease (NOCD; OR 1.42, 95% CI 1.24-1.61, p<0.001). Addition of preoperative SII to a predictive model based on preoperative variables did not improve its accuracy. In preoperative multivariable cox regression, high SII was an independent prognostic factor for recurrence-free survival (RFS; HR 1.13, 95% CI 1.01-1.25, p=0.028), cancer-specific survival (CSS; HR 1.18, 95% CI 1.05-1.33, p=0.005) and overall survival (OS; HR 1.13, 95% CI 1.04-1.24, p<0.006). The addition of SII to a model including established preoperative variables did not improve its C-Index. In multivariable Cox regression including established postoperative variables, high SII revealed no association with any survival outcome. On DCA, the inclusion of the SII did not improve the net-benefit for clinical decision-making regarding LNM, pT3/4 disease or NOCD and survival outcomes. CONCLUSIONS: We confirmed that preoperative SII in patients treated with RC is associated with features of biologically and clinically aggressive BC. However, it did not improve the discriminatory beyond established clinicopathologic features and failed to add clinical benefit for decision making. Together with a panel of complementary BM, it could help identify patients who would benefit from perioperative systemic therapy, more extensive surgical approach and from a closer postoperative follow-up. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1134-e1134 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nico C. Grossmann More articles by this author Victor M. Schuettfort More articles by this author Pawel Rajwa More articles by this author Fahad Quhal More articles by this author Hadi Mostafaei More articles by this author Ekaterina Laukhtina More articles by this author Keiichiro Mori More articles by this author Reza S. Motlagh More articles by this author Abdulmajeed Aydh More articles by this author Satoshi Katayama More articles by this author Benjamin Pradere More articles by this author Marco Moschini More articles by this author Mohammad Abufaraj More articles by this author Dong-Ho Mun More articles by this author Kristin Zimmermann More articles by this author Shahrokh F. Shariat More articles by this author Expand All Advertisement Loading ...