周聖峰、蕭博任、張議徽、陳冠亨、葉進仲、楊啟瑞、黃志平、吳錫金、張兆祥

中國醫藥大學附設醫院泌尿部

¹Sheng-Feng Chou, ²Po-Jen Hsiao, ¹Yi-Huei Chang, ²Guan-Heng Chen, ¹Chin-Chung Yeh, ¹Chi-Rei Yang, ¹Chi-Ping Huang, ¹Hsi-Chin Wu, ¹Chao-Hsiang Chang
¹Department of Urology, China Medical University Hospital, Taichung, Taiwan

²Department of Urology, China Medical University Hospital, Hsinchu, Taiwan

Upper tract urothelial carcinoma(UTUC) with significantly higher prevalence noted in Taiwan. Growing evidence indicates that systemic inflammation response and malnutrition status are correlated with survival in certain types of solid tumors, which may have valuable options for post-OP adjuvant therapy. Several biomarker as NLR or PLR exhibit the potential to predict the prognosis of patients after nephroureterectomy with bladder cuff excision(NUBCE). A novel systemic immune-inflammation index (SII) is a prognostic factor in various malignancies that probably reflects a state of immunity and recently reported to be associated with clinical outcome in several tumors. In this study, we evaluate the prognostic impact of the preoperative SII and its cut off value in patients with localized UTUC without visceral or distant metastasis undergoing laparoscopic or robotic-assisted laparoscopic radical nephroureterectomy with bladder cuff excision, and compare it with NLR and PLR in prognosis, OS and PFS.

We retrospectively analyzed data from patients with localized UTUC undergoing laparoscopic or robotic NUBCE between January 2014 and September 2018 in single tertiary hospital. Patient in active infection status, taking neoadjuvant chemotherapy or radiotherapy, under immunosuppressive medication, having other malignancies, or loss of follow-up more than 1 year were excluded.

The preoperative SII was defined as platelet × neutrophil/lymphocyte counts. The NLR, PLR and SII for each patient were calculated and their optimal cut-off values are identified by a ROC curve(Youden’s index). Kaplan–Meier analyses and Cox proportional hazards models evaluate associations with overall survival (OS) and cancer-specific survival (PFS).

Totally 188 patients were analyzed, and 105 patients was enrolled. The median follow-up duration is 30 months (range:10-56) (Mean:28.8 months). ROC curve is applied to identify the optimal cutoff point in overall survival, which was 3.19 for NLR, 659 for PLR, and 1789 for SII. The AUC for SII was 0.712, which was better than PLR(AUC:0.683) and NLR(AUC:0.671) for predicting overall survival, which indicated SII isn’t inferior than NLR as a predictive factor in UTUC patients. Besides, SII is better than NLR and PLR in predicting PFS.

Preoperative SII was a powerful prognostic biomarker for predicting outcome in operable UTUC patients. Preoperative SII may assist clinicians’ treatment strategy making and individual treatment choice.