腫瘤大小與術前系統性免疫發炎指數對於上泌尿道上皮癌預後的臨床意義
詹皓程 胡哲源 楊文宏 歐建慧
國立成功大學附設醫院 泌尿部
The clinical significance of tumor size and preoperative systemic immune-inflammation index (SII) in oncologic outcomes in patients with upper tract urothelial carcinomas (UTUC)
Hau-Chern Jan, Che-Yuan Hu, Wen-Horng Yang, Chien-Hui Ou.
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Abstract
Purpose
To evaluate the clinical influence of tumor size and preoperative systemic immune-inflammation index (SII) on oncologic outcomes in patients with upper tract urothelial carcinomas (UTUC) after radical nephroureterectomy (RNU)
Methods and materials
We reviewed the medical records of 476 patients with UTUC treated with RNU between January 2005 and December 2017. Clinicopathological data were collected retrospectively for analysis. ROC analyses determined the optimal cut-off value of preoperative SII as 580 according to cancer-specific death. According to tumor size (> 3 and ≤ 3cm) and SII (>580 and ≤ 580), the relationship between two variables was evaluated using t-test. Kaplan-Meier analyses were applied to evaluate cancer-specific survival (CSS) and progression-free survival (PFS). Univariate and multivariate analyses with Cox regression methods were performed to calculate hazard ratios (HRs) for CSS and PFS.
Results
Of the 476 patients, 212 (45%) were tumor size > 3cm and 245 (52%) had a high SII level (> 580). The larger tumor size (> 3cm) was significantly associated with tumor location, pathological tumor stage, lymph node involvement, tumor necrosis, lympho-vascular invasion, and SII. Kaplan-Meier analysis showed significantly poorer CSS and PFS in patients with tumor size > 3 cm (all P < 0.05) and in patients with high SII level (all P < 0.05) than those without. Notably, tumor size > 3cm together with high SII level independently predicted adverse outcome (hazard ratio = 4.147, P = 0.001 for CSS and hazard ratio = 1.677, P = 0.042 for PFS, respectively) in multivariate Cox proportional hazards models. Otherwise, combination of tumor size and SII was also significantly predictive of worse survival in patient with muscle-invasive or non-organ-confined disease (all P < 0.05).
Conclusions
A larger tumor size (> 3cm) combined with high SII (>580) has been demonstrated to be an independent prognostic factor and enable to predict an unfavorable outcome in UTUC patients treated with RNU. Therefore, clinical utilization of tumor size and pre-operative SII is a feasible and useful way to evaluate survivals and select appropriate treatment plans.