PO-094 A novel prognostic significance of combination of preoperative systemic immune-inflammation index and monocyte-lymphocyte ratio in upper tract urothelial carcinoma

Abstract

IntroductionUpper tract urothelial carcinoma (UTUC) is a rare malignancy in urinary system. In order to improve preoperative treatment choice and management of postoperative surveillance, identification of prognostic factors is necessarily required. To our knowledge, the elevation of systemic inflammatory markers may imply the development of an inflammation-associated microenvironment in tumours. The aim of this study is to identify a novel prognosticator, systemic immune-inflammation index (SII, neutrophil x platelet/lymphocyte) and monocyte-lymphocyte ratio (MLR), in patients with UTUC undergoing radical nephroureterectomy (RNU).Material and methodsThe records of 424 patients who underwent RNU at National Cheng-Kung University Hospital, Taiwan from 2007 to 2017 were analysed. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), MLR, and SII for each patient were calculated and their optimal cut-off values were identified by a receiver operating characteristic curve. Sub-classification based on optimal cut-off values of biomarkers was performed. Kaplan–Meier analyses and Cox proportional hazards models evaluated associations with overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). Moreover, logistic regression preoperative models were executed for prediction of advanced disease.Results and discussionsThe median follow-up duration was 35 [interquartile range:14–60] months (Mean:40 months). In multivariable analysis, MLR remained the significant association with OS (p=0.014) and SII significantly influenced on both OS and CSS (p=0.030 and p=0.008, respectively). Further Spearman rank correlation between continuous variables of SII and MLR was 0.374 (P<0.001). Concerning combination of SII and MLR on multivariate analysis, simultaneously high level SII and MLR were significantly associated with OS, CSS, and PFS (all, p<0.05). Moreover, logistic regression preoperative models revealed that simultaneously high level SII and MLR was a significant predictor for non-organ-confined (NOC) UTUC (p=0.002). Further Kaplan–Meier analysis showed that high level SII and MLR was significantly linked to poor OS, CSS and PFS only in patients with NOC UTUC (all, p<0.05).ConclusionOur retrospective study underlines the importance of discovering combination of SII and MLR to significantly predict outcomes in patients with UTUC. Simultaneously high SII and MLR may serve as a significant predictive of NOC UTUC and confers the negative impact on outcomes only in NOC UTUC patients.