腎臟周圍脂肪浸潤並血清免疫發炎指數SII增高作為腎盂尿路上皮癌之預後因子

林杰民、詹皓程、胡哲源、歐建慧

成功大學附設醫院 泌尿部

Peri-renal fat stranding positively linked with increased serum immune-inflammation index as a new promising prognosticator in renal pelvis urothelial carcinoma

Chieh-Ming Lin, Hau-Chern Jan, Che-Yuan Hu, Chien-Hui Ou

Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan

Purpose

To examine the relationship between peri-renal fat stranding (PRFS) and serum immune-inflammation index, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic immune inflammation index (SII), and evaluate its prognostic value in patients with renal pelvic urothelial carcinoma (RPUC) who were treated with radical nephroureterectomy (RNU).

Materials and methods

This retrospective study included 323 patients with localized RPUC who underwent radical nephroureterectomy (RNU) between 2008 and 2021. PRFS was defined as increased density or stranding in the surrounding perirenal adipose tissue on computed tomography (CT) scan. A chi-square and a t-test were used to analyze the association of clinicopathological data with PRFS. Prognostic value for cancer-specific survival (CSS) and progression-free survival (PFS) was assessed using Kaplan-Meier curves and Cox regression models.

Results

RPUC with the presence of PRFS significantly correlated with the increase in serum immune-inflammation index, including NLR, MLR, and SII. Kaplan-Meier analyses showed that PRFS synchronous with increased SII was significantly associated with worse CSS and PFS as compared to none of PRFS or/and increased SII (all P < 0.001). Multivariable Cox regression model indicated that concurrence of PRFS and increased SII was an independent prognostic factor for CSS (HR: 5.502; 95% CI: 2.945-10.280; P < 0.001) and PFS (HR: 5.346; 95%CI: 3.127-9.140; P < 0.001). Furtherover, multivariate logistic regression model revealed combining PRFS and SII can serve as a significant preoperative factor for predicting non-organ-confined disease (HR: 2.726; 95%CI: 1.721-4.318; P < 0.001).

Conclusions

Preoperative presence of PRFS and increased SII together has been demonstrated as an independent factor for worse survival outcomes in patients with RPUC. Concurrent presence of PRFS and increased SII predicted non-organ-confined status of RPUC. Integrating PRFS and SII together can assist individualized treatment planing for high-risk patients requiring systemic therapy pre- or post-surgery.

Keyword: renal pelvic urothelial carcinoma, RPUC, peri-renal fat strandings, PRFS, outcome