This study aimed to evaluate the preoperative prognostic value of systemic inflammation response index and platelet-to-lymphocyte ratio (SIRI-PLR) in patients with upper tract urothelial carcinoma (UTUC). The prognostic ability of SIRI-PLR was evaluated in a training cohort comprising 259 patients with UTUC who underwent radical nephroureterectomy and was further validated in an independent cohort comprising of 274 patients. Multivariate Cox regression models showed that SIRI was significantly associated with overall-survival (OS), cancer-specific survival (CSS), and metastatic-free survival (MFS), and PLR significantly affected OS and CSS (all P < 0.05). In particular, a simultaneously high SIRI-PLR value was considered an independent risk factor even after adjusting for confounding factors and was superior to SIRI alone in predicting survival among patients with UTUC. The analyses of concordance-index and receiver operating characteristic curve showed that incorporation of SIRI-PLR vs. without its incorporation into newly developed nomograms or currently available clinical parameters, such as pathologic T stage, N stage, or tumor grade, had higher accuracy in predicting urologic outcomes of patients with UTUC. These results were observed in the training cohort and were confirmed in the validation cohort. In conclusion, patients with a simultaneously high SIRI-PLR value had significantly poor prognosis. Incorporating SIRI-PLR into currently available clinical parameters can help in patient management.

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.

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Purpose: The prognostic value of obesity in patients with renal cell carcinoma (RCC) remains controversial. This study aimed to assess the sex-dependent prognostic role of body mass index (BMI) in patients with nonmetastatic RCC who underwent radical or partial nephrectomy. Patients and methods: We retrospectively analyzed 643 consecutive patients with nonmetastatic RCC who underwent curative nephrectomy in our center between 2004 and 2014. Associations among BMI, sex, overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were analyzed. Results: Males were more likely to have a higher BMI than females (BMI as a categorical variable: P <0.001; BMI as a continuous variable: P =0.002). In men, a high BMI was significantly correlated with better 5-year OS, CSS, and MFS rates ( P =0.001, 0.014, and 0.001, respectively), and multivariate analysis identified that a high BMI was independently associated with greater OS, CSS, and MFS (OS: hazard ratio [HR]=0.207, P =0.011; CSS: HR=0.225, P =0.005; MFS: HR=0.243, P =0.004). However, in women, there was no significant difference in 5-year OS, CSS, and MFS rates according to BMI ( P =0.781, 0.812, and 0.538, respectively). Moreover, a high BMI was no longer independently associated with OS, CSS, or MFS ( P =0.821, 0.832, and 0.801, respectively). Among patients with clear cell RCC, BMI was significantly associated with OS, CSS, and MFS only among men (all P <0.05) and not among women (all P >0.05). Conclusion: Among patients with nonmetastatic RCC, a high BMI was a favorable prognostic factor in males rather than females. Therefore, sex might influence the correlation between obesity and urological outcomes in nonmetastatic RCC.

Cancer-associated inflammation, activation of coagulation cascades, and malnutrition are closely related to the prognosis of patients with malignancy, including renal cell carcinoma (RCC). This study aimed to investigate the prognostic value of a combination of preoperative plasma fibrinogen, prognostic nutritional index, and monocyte-to-lymphocyte ratio (Fib-PNI-MLR) in patients with non-metastatic RCC undergoing nephrectomy. We retrospectively collected medical data from 829 of the 1,019 cases of RCC. The optimal cutoff values of fibrinogen (≥3.54 vs. &lt;3.54, mg/dl), PNI (&lt;47.03 vs. ≥47.03), and MLR (≥0.29 vs. &lt;0.29) were defined using receiver operating characteristic (ROC) analysis and the Fib-PNI-MLR score (range, 0–3) was determined as the sum of points (0 or 1) assigned to each indicator. As a result, Fib-PNI-MLR was an independent risk factor for overall survival (OS), cancer-specific survival (CSS), and metastatic-free survival (MFS) (all P &lt; 0.05). The concordance-index and area under the curve (AUC) were larger for the Fib-PNI-MLR score than that for other clinical parameters. Subgroup analysis (Fuhrman grade G1+G2 and Fuhrman grade G3+G4; pathologic T1, T2, and T3–4 stage) revealed the significant association of a higher Fib-PNI-MLR score with poor urological outcomes (all P &lt; 0.05). Data indicated that patients with higher Fib-PNI-MLR might benefit from partial nephrectomy. The Fib-PNI-MLR score might serve as a promising prognostic factor in patients with non-metastatic RCC.