Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

Satoshi Katayama,David D’Andrea,Victor M Schuettfort,Mohammad Abufaraj,Shin Egawa,Paweł Rajwa ,Romain Mathiéu ,Éva Compérat ,Benjamin Pradère ,Keiichiro Mori,Ekaterina Laukhtina,Reza Sari Motlagh,Nico C Grossmann,Fahad Quhal,Yasutomo Nasu,Hadi Mostafaei,Marco Moschini,Martin Haydter,Shahrokh F Shariat

doi:10.1007/s00345-021-03740-3

Abstract

PurposeWe assessed the prognostic value of systemic immune-inflammation index (SII) to refine risk stratification of the heterogeneous spectrum of patients with non-muscle-invasive bladder cancer (NMIBC)MethodsIn this multi-institutional cohort, preoperative blood-based SII was retrospectively assessed in 1117 patients with NMIBC who underwent transurethral resection of bladder (TURB) between 1996 and 2007. The optimal cut-off value of SII was determined as 580 using the best Youden index. Cox regression analyses were performed. The concordance index (C-index) and decision curve analysis (DCA) were used to assess the discrimination of the predictive models.ResultsOverall, 309 (28%) patients had high SII. On multivariable analyses, high SII was significantly associated with worse PFS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23–2.77; P = 0.003) and CSS (HR 2.53; 95% CI 1.42–4.48; P = 0.001). Subgroup analyses, according to the European Association of Urology guidelines, demonstrated the main prognostic impact of high SII, with regards to PFS (HR 3.39; 95%CI 1.57–7.31; P = 0.002) and CSS (HR 4.93; 95% CI 1.70–14.3; P = 0.005), in patients with intermediate-risk group; addition of SII to the standard predictive model improved its discrimination ability both on C-index (6% and 12%, respectively) and DCA. In exploratory intergroup analyses of patients with intermediate-risk, the improved discrimination ability was retained the prediction of PFS and CSS.ConclusionPreoperative SII seems to identify NMIBC patients who have a worse disease and prognosis. Such easily available and cheap standard biomarkers may help refine the decision-making process regarding adjuvant treatment in patients with intermediate-risk NMIBC.

Highlights

The standard treatment for non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of bladder (TURB) followed by intravesical instillation chemotherapy or immunotherapy, according to individual patient risk for disease recurrence and progression [1]
On multivariable Cox regression analyses that adjusted for the effects of established confounders, pre-TURB systemic immune-inflammation index (SII) remained associated with both PFS and CSS (HR 1.84; 95% CI 1.23–2.77; P = 0.003, and HR 2.53; 95% CI 1.42–4.48; P = 0.001, respectively) (Table 2)
In this large multi-institutional study, we investigated the clinical value of the preoperative blood-based SII for patients with primary or recurrent NMIBC treated with TURB

Summary

Introduction

The standard treatment for non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of bladder (TURB) followed by intravesical instillation chemotherapy or immunotherapy, according to individual patient risk for disease recurrence and progression [1]. Satoshi Katayama and Keiichiro Mori are first co authors. Extended author information available on the last page of the article. 70% of these patients experience disease recurrence and 30%, eventually, experience progression [2, 3]. Several prognostic models and biomarkers have been investigated as predictors of oncologic outcomes to guide clinical decisionmaking and patient counselling [4, 5]. The immune system, including the inflammatory response and the tumor microenvironment, plays an important role in the clinical and biological behavior and outcomes of bladder cancer (BC) [9]. The systemic immune-inflammation index (SII), an immune and inflammatory index based on neutrophil, lymphocyte, and platelet counts, has been shown

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Conclusion