Preoperative Sarcopenia And Systemic Immune-inflammation Index Can Predict Response To Intravesical Bacillus Calmette-Guerininstillation In Patients With Non-muscle Invasive Bladder Cancer

Background To explore the prognostic significance of sarcopenia and systemic immune-inflammation index(SII)for response to intravesical Bacillus Calmette-Guerin(BCG)in patients with intermediate-,and high-risk non-muscle invasive bladder cancer(NMIBC).Materials and methods We retrospectively analyzed 183 consecutive patients treated in Qilu hospital of Shandong University for a first diagnosis of intermediate and high risk NMIBC(according to EORTC and EAU guidelines)from January 2015 to December 2021.The primary outcome was response to intravesical BCG instillation.According to EAU guidelines,high grade tumor recurrence or progression to muscle invasive bladder cancer(MIBC)during follow-up were considered as BCG non-response in this study,while low grade tumor recurrence should not be considered as BCG non-response.The secondary outcome was relapse-free survival(RFS),defining as the interval from the instillation of BCG therapy to the first recurrence or progression to MIBC.The receiver operating curve(ROC)was used to compare the predictive value of various indicators,and the corresponding best cut-off value was obtained.Logistic regression was used to determine independent predictors of response to intravesical BCG instillation.The univariate and multivariate Cox regression analyses were performed to identify independent prognostic variables affecting RFS after intravesical BCG therapy.Kaplan Meier curves and log rank test were used to compare relapse-free survival between the two groups.A P<0.05 was considered statistically significant.Results Compared with BCG responders,BCG non-responders were associated with sarcopenia(P<0.001),carcinoma in situ(P<0.001),T1 stage(P<0.001),multiple tumor(P<0.001),tumor diameter>=3cm(P<0.001),and have a significant increase of neutrophil-to-lymphocyte ratio(NLR)(P<0.001),platelet to lymphocyte ratio(PLR)(P=0.004),SII(P<0.001).The area under the ROC curve(AUC)of the BMI,NLR,PLR,and SII for response to intravesical BCG immunotherapy were 0.425,0.693,0.631,and 0.702 respectively.Logistic regression analysis demonstrated that sarcopenia and SII were predictors of response to intravesical BCG immunotherapy.The Kaplan-Meier survival analysis showed that the RFS of patients with BCG response,lower SII and no sarcopenia was significantly increased compared with that of patients with BCG non-response,higher SII and sarcopenia,respectively.Subgroup analysis demonstrated that the RFS of patients with high SII and sarcopenia was significantly decreased compared with those with low SII and no sarcopenia in Ta stage subgroup,T1 stage subgroup,non-Cis subgroup,multiple tumor subgroup,single tumor subgroup,tumor diameter≥3cm subgroup and tumor diameter<3cm subgroup,respectively(P<0.05).However,there was no significant difference in RFS for patients in CIS subgroup(P>0.05).Multivariate Cox analysis shown that sarcopenia(P=0.005)and high SII(P=0.003)were significantly associated with poor RFS.Conclusions Both sarcopenia and high SII are useful predictors of response to intravesical BCG in intermediate-and high-risk NMIBC patients.Patients with intermediate-and high-risk NMIBC that had sarcopenia or high SII at diagnosis were associated with poor RFS,and the combination of sarcopenia and SII may be a better predictor of RFS.