Background: Bladder cancer, a frequently encountered urological
malignancy, is a disease of complex management that imposes a significant
burden on society, with an annual global diagnosis exceeding 430,000 men and
women and occupying 10th place among the most common cancers worldwide. Bladder
cancer arises from the transitional epithelium, with urothelial bladder cancer
being the predominant subtype, representing over 90% of cases. Although
considerable progress has been made in the management of high-risk and
muscle-invasive bladder neoplasm in terms of new therapeutic techniques and new
chemo/radiotherapy treatments, it remains a high-mortality tumour, with about
50% of patients developing distant metastasis. The outlook following radical
cystectomy is contingent on histological traits like staging and grading of the
tumour, metastatic condition, involvement of lymphatic nodes, histological
variant, or lymph vascular invasion and vascular infiltration. It would be
advisable to develop a prognostic model and preoperative risk stratification
for those patients most at risk who might need further treatment after surgery.
Although much research has been conducted on the use of blood biomarkers to
improve the follow-up for these patients, there is still much confusion about
this, and no biomarker is standard in the clinical setting. Our retrospective
research aimed to examine the prospective added value of the pan-immune
inflammation value (PIV) index and other known predictive factors and compare
them with other inflammation indices for the oncological outcomes of patients
treated with radical cystectomy (RC). Inflammation is widely acknowledged as a
significant characteristic of cancer, playing a substantial role in both the
initiation and advancement of cancers. This planned to compare pan-immune
inflammation markers and other well-known markers (systemic immune inflammation
index and neutrophil to lymphocyte ratio) to predict prognosis in individuals
treated with radical cystectomy for bladder cancer.
Objective: The objective of the study was to compare PIV with two
other biomarkers, SII and NLR, to provide essential insights into the potential
association between PIV and adverse cancer-related events within a uniformly
characterised and precisely characterised patient cohort.
Methods: The records of 314 patients who underwent radical
cystectomy and lymphadenectomy at the hospital of the researcher from January
2016 to November 2022 were examined. In this retrospective analysis,
preoperative PIV, systemic immune inflammation index (SII), and
neutrophil–lymphocyte ratio (NLR) in 193 individuals managed with radical
cystectomy for bladder cancer were focused on. Multivariable logistic
regression assessments were performed to assess the predictive capabilities of
PIV, SII, and NLR for infiltration of lymph nodes (N), aggressive tumour stage
(pT3/pT4), and any non-organ limited disease at the time of RC. Multivariable
Cox regression analyses were conducted to assess the predictive impact of PIV
on Relapse-free survival (RFS), cancer-specific survival (CSS), and Overall
survival (OS). Statistical analysis was performed using STATA/SE version 18
(StataCorp, College Station, TX, USA). With the ROC curve and the Youden index,
the best cut-offs for each of the biomarkers analysed are determined.
Results: Individuals were divided into high PIV and low PIV
cohorts using the optimal cut-off value (340.96 × 109/L) based on receiver
operating characteristic curve analysis for relapse-free survival. In
multivariable preoperative logistic regression models, only SII and PIV
correlated with the infiltration of lymph nodes, aggressive disease, and any
non-organ-confined disease. In multivariable Cox regression models considering
presurgical clinicopathological variables, a higher PIV was associated with
diminished RFS (p = 0.017) and OS(p = 0.029). In addition, in multivariable Cox
regression models for postoperative outcomes, a high PIV correlated with both
RFS (p = 0.034) and OS (p = 0.048). The key significance of the analysis resides
in the potential benefit for practitioners as a supplementary indicator to
assess the prognosis of Bladder cancer. This can improve the precision of risk
assessment and contribute to more precise treatment-planning decisions,
including the evaluation of adjuvant therapy, neoadjuvant therapy, or
bladder-sparing therapies.
Conclusions: The study suggests that PIV and SII are two very
similar markers that may serve as independent and significant predictors of
aggressive disease and worse survival impacts on individuals undergoing radical
cystectomy for bladder neoplasm. The ability to identify patients with an
aggressive disease profile early on may guide tailored therapeutic
interventions and improve overall clinical results. Further investigation and validation
studies are justified to strengthen the applicability of these biomarkers and
to explore their potential in personalized medicine and treatment optimisation.
Author(s) Details
Palermo Giuseppe
Department
of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo
Francesco Vito 1, 00168 Rome, Italy.
Russo Pierluigi
Department
of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo
Francesco Vito 1, 00168 Rome, Italy.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v7/5364
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