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Minerva Urology and Nephrology 2021 Mar 26

DOI: 10.23736/S2724-6051.21.04023-6


lingua: Inglese

Prognostic effect of preoperative systemic immune-inflammation index in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma

Ekaterina LAUKHTINA 1, 2, Benjamin PRADERE 1, 3, David D'ANDREA 1, Giuseppe ROSIELLO 4, 5, Stefano LUZZAGO 4, 6, Angela PECORARO 4, 7, Carlotta PALUMBO 4, 8, Sophie KNIPPER 4, 9, Pierre I. KARAKIEWICZ 4, Vitaly MARGULIS 10, Fahad QUHAL 1, 11, Reza SARI MOTLAGH 1, Hadi MOSTAFAEI 1, 12, Keiichiro MORI 1, 13, Victor M. SCHUETTFORT 1, 14, Dmitry ENIKEEV 2, Shahrokh F. SHARIAT 1, 2, 15, 16, 17, 18, 19, 20

1 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 2 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 3 Department of Urology, University Hospital of Tours, Tours, France; 4 Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; 5 Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; 6 Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; 7 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; 8 Urology Unit, Department of Medical and Surgical Specialties, ASST Spedali Civili of Brescia, Radiological Science and Public Health, University of Brescia, Brescia, Italy; 9 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; 10 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 11 Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 12 Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 13 Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; 14 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 15 Department of Urology, Weill Cornell Medical College, New York, NY, USA; 16 Department of Urology, University of Texas Southwestern, Dallas, TX, USA; 17 Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; 18 Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; 19 Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; 20 European Association of Urology Research Foundation, Arnhem, Netherlands


BACKGROUND: Identifying those of patients with metastatic renal cell carcinoma (mRCC) who are most likely to benefit from cytoreductive nephrectomy (CN) is challenging. We tested the association between preoperative value of systemic immune-inflammation index (SII) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN.
METHODS: mRCC patients treated with CN at different institutions were included. After assessing for the optimal pretreatment SII cut‐off value, we found 710 to have the maximum Youden index value. The overall population was therefore divided into two SII groups using this cut‐off (low, <710 vs high, ≥710). Univariable and multivariable Cox regression analyses tested the association SII and OS as well as CSS. The discrimination of the model was evaluated with the Harrel’s concordance index (C-index). The clinical value of the SII was evaluated with decision curve analysis (DCA).
RESULTS: Among 613 mRCC patients, 298 (49%) patients had a SII ≥ 710. Median follow-up was 31 (IQR 16-58) months. On univariable analysis, high preoperative serum SII was significantly associated with worse OS (HR: 1.28, 95%CI: 1.07-1.54, p=0.01) and CSS (HR: 1.29, 95%CI: 1.08-1.55, p=0.01). On multivariable analysis, which adjusted for the effect of established clinicopathologic features, SII≥ 710 was associated with OS (HR: 1.25, 95%CI: 1.04-1.50, p=0.02) and CSS (HR: 1.26, 95%CI: 1.05-1.52, p=0.01). The addition of SII only slightly improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.637 vs C-index = 0.629). On DCA, the inclusion of SII did not improve the net-benefit of the prognostic model. On multivariable analyses, SII ≥ 710 remained independently associated with the worse OS and CSS in IMDC intermediate risk group (both: HR: 1.31, 95%CI: 1.02 - 1.67, p = 0.03). In the subgroup analyses based on the BMI, among patients with BMI ≥ 25, SII was significantly associated with OS (HR: 1.29, 95%CI: 1.04 - 1.61, p = 0.02) and CSS (HR: 1.31, 95%CI: 1.05 - 1.63, p = 0.02).
CONCLUSIONS: We found an independent association of high SII prior to CN with unfavorable clinical outcomes, particularly in patients with intermediate risk mRCC and patients with increased BMI. Despite these results, it does not seem to add any prognostic or clinical benefit beyond that obtained by currently available clinicopathologic characteristics as sole worker.

KEY WORDS: mRCC; Cytoreductive nephrectomy; OS; CCS; SII

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