Combination of the Preoperative Systemic Immune-Inflammation Index and Monocyte-Lymphocyte Ratio as a Novel Prognostic Factor in Patients with Upper-Tract Urothelial Carcinoma

• Published in: Annals of surgical oncology Vol. 26; no. 2; pp. 669 - 684
• Main Authors: Jan, Hau-Chern, Yang, Wen-Horng, Ou, Chien-Hui
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers; Biomarkers, Tumor - analysis; Bladder cancer; Female; Follow-Up Studies; Humans; Inflammation; Inflammation Mediators - metabolism; Lymphocytes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Monocytes; Monocytes - pathology; Nephroureterectomy; Oncology; Preoperative Care; Prognosis; Regression analysis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Urologic Neoplasms - immunology; Urologic Neoplasms - pathology; Urologic Neoplasms - surgery; Urologic Oncology; Urothelial carcinoma; Radical Nephroureterectomy (RNU); Lymphocyte–monocyte Ratio (MLR); Upper Tract Urothelial Carcinoma (UTUC); Systemic Immune-inflammation Index (SII); Poor Survival Outcomes
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6942-3

Background This study aimed to evaluate the clinical significance of the preoperative systemic immune-inflammation index (SII) combined with the monocyte-lymphocyte ratio (MLR) for patients with upper-tract urothelial carcinoma (UTUC). Methods The clinical data of 424 patients who underwent radical nephroureterectomy from January 2007 to June 2017 were analyzed. Kaplan–Meier analyses and Cox proportional hazards models were used to evaluate associations of preoperative systemic immune-inflammatory biomarkers with overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Moreover, logistic regression preoperative models were applied to predict advanced disease. Results Multivariate analyses showed that SII significantly influenced both OS and CSS (both P  < 0.05), whereas MLR exhibited the most significant association with OS ( P  = 0.008). In particular, simultaneously high SII and MLR values correlated significantly with OS, CSS, and PFS (all P  < 0.05). Logistic regression preoperative models showed that the combination of high SII and high MLR was a significant predictor of non-organ-confined UTUC ( P  = 0.001). Furthermore, Kaplan–Meier analysis showed that the combination of high SII and high MLR was significantly linked with poor OS, CSS, and PFS in non-organ-confined UTUC (all P  < 0.05). Conclusion The study reviewed serum inflammation biomarkers in a subset of patients with UTUC and demonstrated the ability of combined SII and MLR to predict disease progression and survival. Patients with both high SII and high MLR were significantly more likely to have non-organ-confined disease and poor survival outcomes.