Background Several studies have reported that the systemic immune-inflammation index (SII) is associated with the prognosis of patients with urologic cancers (UCs). The aim of this study was to systematically evaluate the prognostic value of SII in UC patients. Methods We searched public databases for relevant published studies on the prognostic value of SII in UC patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and pooled to assess the relationships between SII and overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), overall response rate (ORR) and disease control rate (DCR). Results A total of 14 studies with 3074 patients were included. From the pooled results, we found that high SII was associated with worse overall survival (OS) in patients with UC (HR 2.58, 95% CI 1.59–4.21). Patients with high SII values also had poorer PFS (HR 1.92, 95% CI 1.29–2.88) and CSS (HR 2.58, 95% CI 1.36–4.91) as well as lower ORRs (HR 0.40, 95% CI 0.22–0.71) than patients with low SII values. In addition, the subgroup analysis of OS and PFS showed that the prognosis of patients with high SII was worse than that of patients with low SII. Conclusions SII might be a promising noninvasive predictor in patients with UC. However, more samples and multicenter studies are needed to confirm the effectiveness of SII in predicting the prognosis of patients with UC.

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ObjectivesCurrent evidence supporting the utility of endoscopic ultrasound‐guided biliary drainage (EUS‐BD) as primary treatment for distal malignant biliary obstruction (MBO) is limited. We conducted a meta‐analysis to compare the performance of EUS‐BD and endoscopic retrograde cholangiopancreatography‐guided biliary drainage (ERCP‐BD) as primary palliation of distal MBO.MethodsWe searched several databases for comparative studies evaluating EUS‐BD vs. ERCP‐BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival.ResultsFour studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [RR] 1.00; 95% confidence interval [95% CI] 0.93–1.08), clinical success (RR 1.00; 95% CI 0.94–1.06) and total adverse events (RR 0.68; 95% CI: 0.31–1.48) between the two procedures. EUS‐BD was associated with lower rates of post‐procedure pancreatitis (RR 0.12; 95% CI 0.02–0.62), stent dysfunction (RR 0.54; 95% CI 0.32–0.91), and tumor in/overgrowth (RR 0.22; 95% CI 0.07–0.76). No differences were noted in reinterventions (RR 0.59; 95% CI 0.21–1.69), procedure duration (weighted mean difference −2.11; 95% CI −9.51 to 5.29), stent patency (hazard ratio [HR] 0.61; 95% CI 0.34–1.11), and overall survival (HR 1.00; 95% CI 0.66–1.51).ConclusionsWith adequate endoscopy expertise, EUS‐BD could show similar efficacy and safety when compared with ERCP‐BD for primary palliation of distal MBO and exhibits several clinical advantages.