Combination of Systemic Inflammation Response Index and Platelet-to-Lymphocyte Ratio as a Novel Prognostic Marker of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

Abstract

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.

Clinical Significance of Systemic Inflammation Response Index and Platelet–lymphocyte Ratio in Patients with Adenocarcinoma of The Esophagogastric Junction and Upper Gastric Cancer

“…In this study, the AUC of SIRI and PLR curve are 0.677 and 0.678, respectively, and the cut-off values are 0.82 and 134.62, respectively, which is similar to the research by Zheng et al [25]. But we found the AUC of PLR in our study is higher than that reported by Zhang et al [37].…”

“…Hu et al [31] found that high-sensitivity C-reactive protein in non-obese radiotherapy patients with malignant tumors could predict grade 4 skin toxicity, and advise doctors to change treatment options. Recently, the prognostic importance of SIRI for patients with renal, pancreatic and nasopharyngeal cancers has been con rmed [25,[32][33][34][35][36]. The higher the SIRI score is, the shorter the disease-free survival and OS.…”

“…Reichert et al [14] found that changes in the peripheral immune microenvironment of the tumor can be re ected by circulating immune-related cells such as neutrophils (N), platelets (P), monocytes (M) and lymphocytes (L). Systemic immune in ammation score (SII) [15][16][17], neutrophil-lymphocyte ratio (NLR) [18,19], platelet-lymphocyte ratio (PLR) [20], lymphocyte-monocyte ratio (LMR) [21], and scoring systems that combine with in ammation index, such as C-reactive protein (CRP)-NLR [22], NLR-PLR [23], Fibrinogen (F)-NLR [24] and SIRI-PLR [25] have been con rmed to evaluate accurately the prognosis of GC and other malignant tumors. Therefore, as a new comprehensive in ammatory index scoring system combining lymphocytes, neutrophils, monocytes and platelets, the systemic in ammatory response index (SIRI) and platelet-lymphocyte ratio (PLR) are expected to predict the prognosis of GC more accurately, and even help clinicians choose appropriate operation methods for AEG and UGC.…”

Evidence of the Prognostic Value of Pretreatment Systemic Inflammation Response Index in Cancer Patients: A Pooled Analysis of 19 Cohort Studies

“…Thereafter, SIRI has been attracted great attention for its predictive value in cancer patients [ 6 – 9 ]. SIRI was reported to be associated with clinicopathological characteristics and prognosis in a variety of tumors [ 10 , 11 ]. For instance, the higher-SIRI patients with renal cell carcinoma had deeper invasion, advanced N stage, and larger tumor size as well as shorter survival time [ 10 ].…”

“…For instance, the higher-SIRI patients with renal cell carcinoma had deeper invasion, advanced N stage, and larger tumor size as well as shorter survival time [ 10 ]. And in upper tract urothelial carcinoma, SIRI level was found to be related with pathologic T stage, N stage, and lymphovascular invasion, and the SIRI could also be an independent prognostic indicator for overall survival, cancer-specific survival, and metastasis-free survival among these patients [ 11 ].…”