泛免疫發炎值是上泌尿道上皮癌新的且有前景的預後生物標誌物
郁廉靖、胡哲源、楊文宏、歐建慧、詹皓程
國立成功大學醫學院附設醫院泌尿部
The Pan-Immune-Inflammation Value is a New Prognostic Biomarker in Upper Tract Urothelial Carcinoma
Lian-Ching Yu, Che-Yuan Hu, Wen-Horng Yang, Chien-Hui Ou, Hau-Chern Jan
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
Background
Blood-based immune-inflammation markers showed a prognostic relevance in patients with upper tract urothelial carcinoma. We aimed at evaluating the prognostic power of a novel comprehensive biomarker, the pan-immune-inflammation value (PIV), in patients with UTUC.
Methods
The clinical data of 567 patients with UTUC who underwent radical nephroureterectomy (RNU) at National Cheng-Kung University Hospital from 2008 to 2019 were analyzed. PIV was calculated as: (neutrophil count × platelet count × monocyte count)/lymphocyte count. An optimal cut-off of PIV was determined using ROC analysis with Youden’s index based on cancer-specific death as the endpoint. The Kaplan–Meier method and Cox hazards regression models were used for survival analyses.
Results
A total of 567 patients were included. Overall, 280 patients (49%) had a high-level PIV and 287 (51%) had a low-level PIV. A high-level PIV was closely associated with multifocal tumors, advanced pT stage, lymph node metastasis, larger tumor size, and presence of tumor necrosis and LVI. Patients with high PIV had a significant association with a worse OS, CSS, and PFS compared to those with low-level PIV (all, P < 0.001). In the multivariable analysis. PIV was shown to be an independent factor for predicting a poor OS (HR, 2.394; 95% CI, 1.640–3.493; P < 0.001), CSS (HR, 2.293; 95% CI, 1.482–3.548; P < 0.001), and PFS (HR, 1.796; 95% CI, 1.310–2.461; P < 0.001).
Conclusion
PIV is a new promising predictor of survival outcomes in patients with UTUC treated with RNU. PIV should be prospectively validated to better stratify UTUC patients potentially requiring systemic therapy thereafter.