Association of preoperative systemic Immune-inflammation Index and Prognostic Nutritional Index with survival in patients with Upper Tract Urothelial Carcinoma

Yangqin Zheng; Dongdong Yu; Zhixian Yu; Dewei Zhao; Yuming Chen; Wu Chen; Yeping Li; Binwei Lin; Xiaomin Gao

doi:10.7150/jca.44915

Association of preoperative systemic Immune-inflammation Index and Prognostic Nutritional Index with survival in patients with Upper Tract Urothelial Carcinoma

J Cancer. 2020 Jul 25;11(19):5665-5677. doi: 10.7150/jca.44915. eCollection 2020.

Authors

Yangqin Zheng¹, Dongdong Yu², Zhixian Yu³, Dewei Zhao⁴, Yuming Chen⁵, Wu Chen⁶, Yeping Li³, Binwei Lin⁷, Xiaomin Gao⁸

Affiliations

¹ Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang province, 325006, P.R. China.
² Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang province, 325006, P.R. China.
³ Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang province,325006, P.R. China.
⁴ Department of Urology, Wenzhou Central Hospital, Wenzhou, Zhejiang province, 325200, P.R. China.
⁵ Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu province, 225001, P.R. China.
⁶ Department of Urology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang province, 325006, P.R. China.
⁷ Department of Urology, Rui'an People's Hospital, The Third Affiliated Hospital of the Wenzhou Medical University, Wenzhou, Zhejiang province, 325200, P.R. China.
⁸ Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, P.R. China.

Abstract

Background: Both systemic inflammation response and malnutrition are closely related to poor prognosis in patients with certain types of solid tumor. This study investigated the prognostic value of the preoperative combination of systemic immune-inflammation index and prognostic nutritional index (SII-PNI) in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods: The predictive ability of SII-PNI was developed and further validated in a cohort of 525 UTUC patients (253 in the training cohort and 272 in the validation cohort) who received RNU. Results: Survival analysis indicated that a SII ≥672.44 was significantly associated with worse overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) while a PNI ≥47.83 was associated with better survival outcomes (All P-values < 0.05). The combination of simultaneously SII ≥672.44 and PNI <47.83 was a powerful independent risk factor for OS, CSS, and RFS (P < 0.05). The SII-PNI had the largest area under the curve (AUC) compared to that for SII or PNI alone and other clinical factors, indicating its superior for predicting survival. In addition, the incorporation of the SII-PNI into established nomograms or current clinical parameters such as pathologic T stage and N stage, achieved higher c-indexes or larger AUC than without, indicating that adding SII-PNI helped predict prognosis. All results were found in the training cohort and confirmed in the validation cohort. Conclusions: SII-PNI was a strong independent predictor of UTUC patients after RNU.

Keywords: prognosis; prognostic nutritional index; systemic immune-inflammation index; upper tract urothelial carcinoma.