Preoperative systemic inflammation response index is an independent prognostic marker for BCG immunotherapy in patients with non‐muscle‐invasive bladder cancer

Abstract

Background The Systemic Inflammatory Response Index (SIRI) is a novel prognostic biomarker based on peripheral blood counts of neutrophils, monocytes, and lymphocytes. Recent evidence suggests that it is associated with poor prognosis in various cancers. However, the predictive value of the SIRI in non‐muscle‐invasive bladder cancer (NMIBC) patients treated with intravesical Bacillus Calmette‐Guerin (BCG) immunotherapy remains elusive. Therefore, this study aimed to evaluate the potential of SIRI as a prognostic factor in these patients. Methods A total of 540 patients with NMIBC who underwent BCG immunotherapy following transurethral resection of bladder tumor (TURBT) were enrolled in this study. Using receiver operating characteristic (ROC) curves and the Youden index, patients were divided into high and low SIRI groups based on the cutoff values. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of BCG non‐response. Thereafter, propensity score matching (PSM) was used to eliminate bias due to confounding factors between the low and high SIRI groups. Finally, the Kaplan–Meier method was used to compare recurrence‐free survival (RFS) and progression‐free survival (PFS) between the two groups. Results Multivariable logistic regression analysis revealed that high SIRI (p = 0.001), high MLR (p = 0.015), and high tumor pathological T stage (p = 0.015) were significantly correlated with non‐response to BCG therapy. In addition, both RFS and PFS were shorter in the high SIRI group than in the other group before and after PSM (both p < 0.05). Collectively, our results indicate that the combination of tumor pathological T staging and the SIRI can enhance the predictive power of BCG response. Conclusion Pretreatment peripheral blood SIRI can be employed to predict the response to BCG immunotherapy and the prognosis of NMIBC patients. Taken together, the combination of T stage and SIRI demonstrated robust performance in predicting the response to BCG immunotherapy in NMIBC patients.

Clinical, Laboratory, Histological, Radiological, and Metabolic Features and Prognosis of Malignant Pleural Mesothelioma

“…Continuous variables were described by using the median and interquartile range (IQR). Receiver operated characteristics (ROC) curves were constructed to determine cutoff values of laboratory indicators that yield the joint maximum sensitivity and specificity [18][19][20]. Continuous variables are converted to category variables by optimal cut-off values.…”

A risk model based on lncRNA-miRNA-mRNA gene signature for predicting prognosis of patients with bladder cancer

“…The median value of risk score in training dataset was considered the cut-off point as classifying cohort to high- and low-risk group. Subsequently, we analyzed the OS with Kaplan-Meier plots and used the receiver operating characteristic (ROC) analysis to evaluate their performance using the value of area under curve (AUC) [ 27 , 28 ]. The same analysis was performed in the validation cohorts of GSE13507.…”

Immune Predictors of Response after Bacillus Calmette–Guérin Treatment in Non-Muscle-Invasive Bladder Cancer

“…There are other systemic indicators that have been studied, such as the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and the systemic inflammatory response index (SIRI), which includes neutrophils, monocytes, and lymphocytes (SIRI = neutrophil count x monocyte count/lymphocyte count). SIRI includes the count of three different immune cell types, and a high SIRI has been reported to correlate with shorter median RFS (recurrence-free survival) and PFS (progression-free survival) in NMIBC patients after BCG treatment [57]. In a retrospective study, blood samples of patients prior to surgery were analyzed to calculate the different inflammatory indices (PLR, NLR, MLR, and SIRI).…”