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Vol. 47. Issue 7.
Pages 430-440 (September 2023)
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Vol. 47. Issue 7.
Pages 430-440 (September 2023)
Original article
Immune-inflammatory-nutritional status predicts oncologic outcomes after radical cystectomy for urothelial carcinoma of bladder
El estado inmunológico-inflamatorio-nutricional predice los resultados oncológicos tras la cistectomía radical por carcinoma urotelial de vejiga
K. Tekea, I.E. Avcia,
Corresponding author
erkutavci@gmail.com

Corresponding author.
, N.B. Cinara, E.A. Baynala, E. Bosnalib, S. Polatc, H. Yilmaza, O. Karaa, O. Dillioglugila
a Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
b Department of Urology, Derince Education and Research Hospital, Kocaeli, Turkey
c Department of Urology, Amasya University, Amasya, Turkey
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Tables (2)
Table 1. Patients’ characteristics according to preoperative INS groups.
Table 2. Univariate and multivariate analysis of OS and RFS in 173 ORC patients who had urothelial carcinoma of bladder.
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Abstract
Objective

To perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC).

Materials and Methods

The records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and Prognostic Nutritional Index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: “high SII-high PNI”, “low SII-high PNI”, “low SII-low PNI”, and “high SII-low PNI”. The Low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS).

Results

After exclusions, the final cohort size was 173 patients. The mean age was 64.31 ± 8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n = 89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n = 84) was a worse independent prognostic factor for OS (HR: 1.509, 95%CI: 1.104–3.145, p = 0.001) and RFS (HR: 1.285; 95%CI: 1.009–1.636, p = 0.042).

Conclusion

Preoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

Keywords:
Bladder cancer
Radical cystectomy
SII
PNI
Immune inflammatory
Nutrition
Resumen
Objetivo

Evaluar por primera vez el papel del estado inmunológico-inflamatorio-nutricional (EIIN) en los resultados oncológicos de pacientes sometidos a cistectomía radical abierta (CRA) por carcinoma urotelial (CU).

Materiales y métodos

Se analizaron retrospectivamente los registros de pacientes consecutivos sometidos a CRA por cáncer de vejiga no metastásico entre 2009 y 2020. La quimioterapia neoadyuvante, el tumor no urotelial y la ausencia de seguimiento oncológico fueron criterios de exclusión. Se calcularon los valores del índice de inmunidad-inflamación sistémica (IIS) y del índice pronóstico nutricional (IPN) y se utilizaron los valores de corte óptimos para estos, con el fin de designar cuatro subgrupos: " IIS alto – IPN alto ", " IIS bajo – IPN alto ", " IIS bajo – IPN bajo " y " IIS alto – IPN bajo ". El grupo de EIIN con IIS bajo-IPN alto tuvo la mejor tasa de supervivencia global (SG), mientras que el resto se incluyó en el grupo de EIIN desfavorable. Se elaboraron curvas de supervivencia y se utilizó un modelo de regresión de Cox multivariante para la SG y la supervivencia libre de recidiva (SLR).

Resultados

Tras aplicar los criterios de exclusión, el tamaño final de la cohorte fue de 173 pacientes. La edad media fue de 64,31 ± 8,35 y la mediana de seguimiento fue de 21 (RIQ: 9-58) meses. Los valores de corte óptimos para IIS y IPN fueron 1216 y 47, respectivamente. El grupo de EIIN favorable (IIS bajo-IPN alto, n = 89) tuvo la mejor tasa de SG (62,9%). El análisis multivariante de regresión de Cox indicó que el EIIN desfavorable (n = 84) era un factor independiente de pronóstico para una SG peor (HR: 1,509; IC 95%: 1,104−3,145; p = 0,001) y la SLR (HR: 1,285; IC 95%: 1,009−1,636; p = 0,042).

Conclusión

La evaluación preoperatoria del EIIN puede constituir un panel útil para el pronóstico de la SG y la SLR en pacientes sometidos a CRA por CU.

Palabras clave:
Cáncer de vejiga
Cistectomía radical
IIS
IPN
Inmunidad inflamación
Nutrición

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