| ObjectiveBladder cancer is one of the common malignant tumors in the urinary system.About 75%of patients with bladder cancer are non-invasive bladder cancer(NMIBC).Transurethral resection of bladder tumor(TURBT)combined with postoperative perfusion chemotherapy is currently the standard treatment for patients with NMIBC,but there is a high recurrence rate and progression rate after operation.Therefore,it is important to evaluate the prognosis of patients with NMIBC.Preoperative systemic immune-inflammatory index(SII)has been demonstrated to be associated with the prognosis of a variety of malignancies,but studies on the prognostic value of preoperative SII in patients with NMIBC are rarely reported.The aim of this study was to investigate the value of SII in the prognostic evaluation of patients with NMIBC and to construct a prediction model to provide a reference for assessing the prognosis of patients.MethodsThe clinical data of 271 patients with NMIBC who were newly diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2017 were retrospectively analyzed.SII were calculated based on the blood routine results one week before surgery.The optimal cut-off value of SII was calculated using the receiver operating characteristic(ROC)curve,and the patients were divided into high SII and low SII groups.The correlation between preoperative SII and the clinicopathological characteristics of the patients was analyzed.The survival curves were plotted using Kaplan-Meier method and their differences were tested with the Log-rank test.Univariate and multivariate analyses were performed using Cox regression model.A nomogram was constructed to predict the prognosis of patients with NMIBC based on the independent prognostic risk factors.The prediction accuracy and consistency of the nomogram were assessed by the concordance index(C-index)and the calibration curve.Results(1)A total of 271 patients were included in this study,including 209 males(77.1%)and 62 females(22.9%).The age range of the patients was 22-86 years old,with a median age of 59(49,66)years old.The median value of SII was 356.13(257.09,509.26).The optimal cut-off value of SII confirmed by ROC curve was 383,and the patients were divided into low SII group(n=152,SII<383)and high SII group(n=119,SII>383).In the intra-group comparison,the pathological T stage,tumor recurrence rate,and progression rate in the high SII group were significantly higher than those in the low SII group(P<0.05).(2)The follow-up time of this study was 12-82 months,and the median follow-up time was 56 months.The survival curves showed that the recurrence-free survival(RFS)and progression-free survival(PFS)rates of patients in the low SII group were better than those of patients in the high SII group(both P<0.001).Univariate Cox regression analysis showed that high preoperative SII level was a factor affecting RFS and PFS in patients with NMIBC(both P<0.001).Multivariate Cox regression analysis showed that multiple tumors,pathological T1 stage,high-grade tumors and SII≥383(HR=2.711,95%CI:1.574-4.670,P=0.001)were independent risk factors for RFS in NMIBC patients.Multiple tumors,high-grade tumors and SII≥383(HR=3.034,95%CI:1.363-6.754,P=0.007)were independent risk factors for PFS in NMIBC patients.(3)The C-index of internal verification of the nomogram prediction model for 1-year,3-year,and 5-year RFS and PFS in NMIBC patients was 0.818(95%CI:0.768-0.868)and 0.832(95%CI:0.758-0.906),respectively,indicating high nomogram prediction accuracy.The calibration curves showed good agreement between the nomogram predictions and the actual results.ConclusionPreoperative SII can be used as an indicator to evaluate the prognosis of patients with NMIBC,and higher preoperative SII levels may indicate worse prognosis of NMIBC patients.The nomogram constructed according to independent risk factors has high predictive value and can provide a reference for evaluating the prognosis of patients with NMIBC and making individualized treatment plan. |
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