Role of systemic immune-inflammation index in patients treated with salvage radical prostatectomy

Pawel Rajwa,Andrzej Paradysz,Nico C Grossmann,Ekaterina Laukhtina,Pierre I Karakiewicz,Benjamin Pradere,Fahad Quhal,Kristin Zimmermann,Harun Fajkovic,Hadi Mostafaei,Shahrokh F Shariat,Reza Sari Motlagh,Keiichiro Mori,Paolo Gontero,Andreas Aulitzky,Victor M Schuettfort,Axel Heidenreich,Satoshi Katayama

doi:10.1007/s00345-021-03715-4

Abstract

PurposeTo examine the predictive and prognostic value of preoperative Systemic Immune-inflammation Index (SII) in patients with radio-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP).Materials and methodsThis multicenter retrospective study included 214 patients with radio-recurrent PCa, treated with SRP between 2007 and 2015. SII was measured preoperatively (neutrophils × platelets/lymphocytes) and the cohort was stratified using optimal cut-off. Uni- and multivariable logistic and Cox regression analyses were performed to evaluate the predictive and prognostic value of SII as a preoperative biomarker.ResultsA total of 81 patients had high preoperative SII (≥ 730). On multivariable logistic regression modeling, high SII was predictive for lymph node metastases (OR 3.32, 95% CI 1.45–7.90, p = 0.005), and non-organ confined disease (OR 2.55, 95% CI 1.33–4.97, p = 0.005). In preoperative regression analysis, high preoperative SII was an independent prognostic factor for cancer-specific survival (CSS; HR 10.7, 95% CI 1.12–103, p = 0.039) and overall survival (OS; HR 8.57, 95% CI 2.70–27.2, p < 0.001). Similarly, in postoperative multivariable models, SII was associated with worse CSS (HR 22.11, 95% CI 1.23–398.12, p = 0.036) and OS (HR 5.98, 95% CI 1.67–21.44, p = 0.006). Notably, the addition of SII to preoperative reference models improved the C-index for the prognosis of CSS (89.5 vs. 80.5) and OS (85.1 vs 77.1).ConclusionsIn radio-recurrent PCa patients, high SII was associated with adverse pathological features at SRP and survival after SRP. Preoperative SII could help identify patients who might benefit from novel imaging modalities, multimodal therapy or a closer posttreatment surveillance.

Highlights

Radiation therapy is an effective therapy for localized prostate cancer (PCa) with durable local control [1, 2]
We retrospectively reviewed data from five academic centers including patients with clinical non-metastatic radiationrecurrent PCa treated with salvage radical prostatectomy (SRP) between 2007 and 2015
214 patients with radio-recurrent PCa, who underwent SRP were included in our analyses

Summary

Introduction

Radiation therapy is an effective therapy for localized prostate cancer (PCa) with durable local control [1, 2]. Up to 50% of patients experience biochemical recurrence (BCR), which is associated with subsequent risk of metastasis and PCa-specific death [3,4,5] While some of these patients develop distant recurrence, a large proportion would benefit from effective local salvage therapy [2]. Extended author information available on the last page of the article with 53% 5-year recurrence-free survival (RFS) and over 70% 10-year cancer-specific survival (CSS) [2, 6] These favorable long-term outcomes after SRP comes at the cost of potentially significant adverse events, including incontinence, improvement has been reported in recent years [2, 6,7,8]. The Systemic Immune-inflammation Index (SII) is a novel biomarker, which combines three immune cell counts into a simple formula: neutrophils × platelets/

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