Prognostic role of the systemic immune–inflammation index in upper tract urothelial carcinoma treated with radical nephroureterectomy: results from a large multicenter international collaboration

Abstract

Purpose To investigate the prognostic role of the preoperative systemic immune–inflammation index (SII) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and methods We retrospectively analyzed our multi-institutional database to identify 2492 patients. SII was calculated as platelet count × neutrophil/lymphocyte count and evaluated at a cutoff of 485. Logistic regression analyses were performed to investigate the association of SII with muscle-invasive and non-organ-confined (NOC) disease. Cox regression analyses were performed to investigate the association of SII with recurrence-free, cancer-specific, and overall survival (RFS/CSS/OS). Results Overall, 986 (41.6%) patients had an SII > 485. On univariable logistic regression analyses, SII > 485 was associated with a higher risk of muscle-invasive (P = 0.004) and NOC (P = 0.03) disease at RNU. On multivariable logistic regression, SII remained independently associated with muscle-invasive disease (P = 0.01). On univariable Cox regression analyses, SII > 485 was associated with shorter RFS (P = 0.002), CSS (P = 0.002) and OS (P = 0.004). On multivariable Cox regression analyses SII remained independently associated with survival outcomes (all P < 0.05). Addition of SII to the multivariable models improved their discrimination of the models for predicting muscle-invasive disease (P = 0.02). However, all area under the curve and C-indexes increased by < 0.02 and it did not improve net benefit on decision curve analysis. Conclusions Preoperative altered SII is significantly associated with higher pathologic stages and worse survival outcomes in patients treated with RNU for UTUC. However, the SII appears to have relatively limited incremental additive value in clinical use. Further study of SII in prognosticating UTUC is warranted before routine use in clinical algorithms.

Discordance Between Clinical and Pathological Staging and Grading in Upper Tract Urothelial Carcinoma

“…Moreover, given that high-grade URS biopsy and cytology were significantly associated with higher disease upstaging rates than low-grade biopsy and cytology, in the univariable analysis, the URS biopsy is suggestive of problems in reliability for staging high-grade UTUC. Ways to overcome the sampling issue are the use of an access sheath that allows for repeated sampling, imaging, and make for biomarkers [23][24][25][26][27] .…”

The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy

“…The combination had the largest area under the curve compared to that for SII or PNI alone and other clinical factors, indicating its advantage in predicting survival. A large multi-institutional cohort from the international UTUC collaboration study that included 2492 cases with RNU showed that altered SII was significantly associated with higher pathologic stages and worse survival outcomes [6]. Additionally, the decision curve analysis was used to evaluate the clinical benefit of SII.…”

“…During initial diagnosis, almost 60% of UTUCs were invasive, which is higher than that in UBUC [3]. Several studies have attempted to identify prognostic factors in patients with UTUC [3][4][5][6]. These models are based on age, tumor grade, pathologic tumor grade, lymph node metastasis, lymph vascular invasion, tumor multifocality, and tumor architecture [3][4][5][6].…”

“…Several studies have attempted to identify prognostic factors in patients with UTUC [3][4][5][6]. These models are based on age, tumor grade, pathologic tumor grade, lymph node metastasis, lymph vascular invasion, tumor multifocality, and tumor architecture [3][4][5][6]. With the development of current genomics studies of UTUC [7], physicians can integrate the clinical pathologic characteristics with genetic and molecular subtyping of UTUC.…”

“…The prognostic significance of SII in UTUC or its relative utility when compared with other inflammatory indexes has not been fully investigated. Currently, only a few studies [6,22,23] have reported the predictive value of the SII as a predictor of UTUC treated by radical nephroureterectomy. In the present study, we retrospectively enrolled 376 patients and investigated the prognostic significance of SII in UTUC patients.…”