Predictive value of prognostic nutritional index and systemic immune‐inflammation index on tumor progression in bladder cancer patients with after radical cystectomy

Abstract OBJECTIVES: The purpose of this study was to explore the predictive value of preoperative prognostic nutritional index(PNI) and systemic immune‐inflammation index(SII) for local tumor stage in bladder cancer(BC) after radical cystectomy(RC).METHODS: We researched our database between April 2011 and October 2019. There were 195 BC patients who underwent RC. The PNI and SII were calculated using preoperative blood sample results. The predictive value of SII and PNI was analysed with univariate and multivariate Cox regression models. Receiver operating characteristic (ROC) was used to determine the optimum PNI. Signifcant P was P<0.05.RESULTS: Of patients, all patients were males with a mean age of 67.94±8.97years. Mean serum albumin was 42.13±4.28(g/L), mean PNI score was 51.29±6.09 and mean SII was 661.67±506.22. Multivariable Cox regression analysis demonstrated that PNI scores and SII could not play a significantly predictive factor between muscle invasive bladder cancer(MIBC) and non-muscle-invasive bladder cancer(NMIBC). While we also found PNI was an independent risk factors for predicting tumor stagep(pT＜3a and pT≥3a).CONCLUSIONS: Our research revealed that preoperative low PNI but not SII could be used as an independent factor to predict worse pathologically stage(pT≥3a). But preoperative PNI and SII might not were significantly related with the incidence risk of muscle invasive. We still need future studies with large cohorts to identify our results.

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Predictive Value of Prognostic Nutritional index and Systemic Immune‐Inflammation Index on Tumor Progression in Bladder Cancer Patients with After Radical Cystectomy

10.21203/rs.3.rs-201709/v1 ◽

2021 ◽

Author(s):

jiatong zhou ◽

xitong xu ◽

ranlu liu

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Predictive Value ◽

Cox Regression ◽

Prognostic Nutritional Index ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Nutritional Index ◽

Immune Inflammation ◽

Muscle Invasive

Abstract OBJECTIVES: The purpose of this study was to explore the predictive value of preoperative prognostic nutritional index(PNI) and systemic immune‐inflammation index(SII) for local tumor stage in bladder cancer(BC) after radical cystectomy(RC).METHODS: We researched our database between April 2011 and October 2019. There were 195 BC patients who underwent RC. The PNI and SII were calculated using preoperative blood sample results. The predictive value of SII and PNI was analysed with univariate and multivariate Cox regression models. Significant P was P<0.05.RESULTS: Of patients, all patients were males with a mean age of 67.94±8.97years. Mean serum albumin was 42.13±4.28(g/L), mean PNI score was 51.29±6.09 and mean SII was 661.67±506.22. Multivariable Cox regression analysis demonstrated that PNI scores and SII could not play a significantly predictive factor between muscle invasive bladder cancer(MIBC) and non-muscle-invasive bladder cancer(NMIBC). While we also found PNI was an independent risk factors for predicting tumor stagep(pT＜3a and pT≥3a).CONCLUSIONS: Our research revealed that preoperative low PNI but not SII could be used as an independent factor to predict worse pathologically stage(pT≥3a). We still need future studies with large cohorts to identify our results.

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Using radiologic response to predict prognosis in patients with muscle-invasive bladder cancer undergoing carboplatin-based neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.361 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 361-361

Author(s):

Shingo Hatakeyama ◽

Hayato Yamamoto ◽

Akiko Okamoto ◽

Atsushi Imai ◽

Takahiro Yoneyama ◽

...

Keyword(s):

Bladder Cancer ◽

Multivariate Analysis ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Cox Regression ◽

Disease Free Survival ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Contrast Enhanced Ct ◽

Muscle Invasive

361 Background: Prognosis and tumor responses of carboplatin-based neoadjuvant chemotherapy for muscle invasive bladder cancer (MIBC) are not well documented. To assess the usefulness of carboplatin-based neoadjuvant chemotherapy, we examined the correlation between radiological responses and pathologic down staging on radical cystectomy (RCx) specimens, disease free survival (DFS), and overall survival (OS). Methods: Between March 2005 and June 2013, we performed carboplatin-based neoadjuvant chemotherapy followed by radical cystectomy in 115 patients with T2-4NxM0 MIBC. After diagnostic TUR biopsy, all participants received two courses of Gemcitabine plus Carboplatin therapy. Baseline and post chemotherapy tumor size from contrast enhanced CT were reviewed. The patients were divided in two groups between responders (CR+PR), and non-responders (SD+PD). RCx and bilateral pelvic lymphadenectomy were performed approximately within a month after cessation of chemotherapy. DFS and OS distributions within radiologic response subgroups were estimated with the Kaplan-Meier method and compared using the log-rank test. To evaluate independent predictor for DFS and OS, age, gender, performance status, pathological T and N stage, down-staging, tumor grade, renal function, and radiological responses were applied by Cox-regression multivariate analysis. Results: No significant differences were observed in patient backgrounds between the groups. Radiologic responses were observed in 75 (65%) patients with 69±24% decrease in responder group, whereas tumor response was 2.8±14% in non-responders. The rate of pathological down staging to <pT2 was 37 (49%) in responders, 5 (13%) in non-responders group. Radiologic response was a strong predictor of DFS and OS. A 5-year advantages of DFS and OS in responders vs. non-responders were 88% and 86% vs. 64% and 69%, respectively (P=0.021 and P=0.013). Multivariate analysis showed radiologic response was the independent factor for DFS and OS. Conclusions: Radiological response post carboplatin-based neoadjuvant chemotherapy is associated with OS in patients with MIBC.

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Systemic therapy and overall survival trends in patients with non-urothelial histologic variants of muscle invasive bladder cancer undergoing radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.376 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 376-376 ◽

Cited By ~ 1

Author(s):

Shreyas Joshi ◽

Elizabeth Handorf ◽

Andres Correa ◽

Alexander Kutikov ◽

Benjamin T. Ristau ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Survival Benefit ◽

Cox Regression ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Kaplan Meier ◽

Muscle Invasive

376 Background: Histological variants of urothelial carcinoma (UC) of the bladder have a poorer prognosis than histologically pure UC, and the role of neoadjuvant chemotherapy (NAC) in this group is unclear. Our objective was to evaluate NAC practice patterns and survival outcomes in patients with histologic variants undergoing radical cystectomy (RC). Methods: Patients with cT2-4N0-3M0 muscle invasive bladder cancer (MIBC) who underwent RC from 2003-2012 were selected from the National Cancer Database (NCDB). Patients were categorized by histology code as pure UC or histologic variants. Adjusting for patient and clinical characteristics, generalized estimating equations were used to test the association between histology and receipt of NAC. The association between receipt of NAC and overall survival (OS) was evaluated using Kaplan Meier curves and Cox regression models. Results: In 19,976 patients meeting inclusion criteria, receipt of NAC in histologic variants was less (11-14%) than in pure UC (22%), with the exception of micropapillary disease (23%) (Table). Median OS was lower in variant histologies than for pure UC (8.4 – 30.2 vs. 37.6 months). Receipt of NAC was associated with improved survival compared to RC or RC+adjuvant chemotherapy in patients with pure UC (HR 0.91, p=0.0016). There was no evidence of a survival benefit for NAC in the variant histologies, or that treatment effects differed by histology (P-val for interaction=0.84). Conclusions: In the NCDB, a substantial proportion of patients (13%) with histologic variants of MIBC undergoing RC receive NAC in the absence of a proven survival benefit. Clinical trials inclusive of patients with variant histologies are necessary to elucidate the role of NAC prior to RC. [Table: see text]

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Recurrence in Non-Muscle Invasive Bladder Cancer Patients: External Validation of the EORTC, CUETO and EAU Risk Tables and Towards a Non-Linear Survival Model

Bladder Cancer ◽

10.3233/blc-200305 ◽

2020 ◽

Vol 6 (3) ◽

pp. 277-284

Author(s):

Marit Lucas ◽

Ilaria Jansen ◽

Jorg R. Oddens ◽

Ton G. van Leeuwen ◽

Henk A. Marquering ◽

...

Keyword(s):

Bladder Cancer ◽

Risk Stratification ◽

Predictive Value ◽

Cox Regression ◽

External Validation ◽

Cox Proportional Hazards ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Non Linear ◽

Muscle Invasive

BACKGROUND: EORTC, CUETO and EAU are the most commonly used risk stratification models for recurrence and progression in non-muscle invasive bladder cancer (NMIBC). OBJECTIVE: We assessed the predictive value of the EORTC, CUETO and EAU risk group stratification methods for our population and explore options to improve the predictive value using Cox Proportional Hazards (CPH), Boosted Cox regression and a non-linear Random Survival Forest (RSF) model. MATERIALS: Our retrospective database included of 452 NMIBC patients who underwent a transurethral resection of bladder tumor (TURBT) between 2000 and 2018 in our hospital. The cumulative incidence of recurrence was calculated at one- and five-years for all risk stratification methods. A customized CPH, Boosted Cox and RSF models were trained in order to predict recurrence, and the performances were compared. RESULTS: Risk stratification using the EORTC, CUETO and EAU showed small differences in recurrence probabilities between the risk groups as determined by the risk stratification. The concordance indices (C-index) were low and ranged between 0.51 and 0.57. The predictive accuracies of CPH, Boosted Cox and RSF models were also moderate, with C-indices ranging from 0.61 to 0.64. CONCLUSIONS: Prediction of recurrence in patients with NMIBC based on patient characteristics is difficult. Alternative (non-linear) approaches have the potential to improve the predictive value. Nonetheless, the currently used characteristics are unable to properly stratify between the recurrence risks of patients.

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A single-center experience of chemotherapy for muscle-invasive bladder cancer after radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.318 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 318-318

Author(s):

Adam S. Kotowski ◽

Andrew Stegemann ◽

Shabnam Rehman ◽

Kristopher Attwood ◽

Ellis Glenn Levine ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Small Sample ◽

Invasive Bladder Cancer ◽

Hematologic Toxicity ◽

Muscle Invasive Bladder Cancer ◽

Grade 3 ◽

Muscle Invasive

318 Background: Muscle invasive bladder cancer (MIBC) is a chemo-sensitive disease that responds to therapy before or after curative-intent radical cystectomy (RC). Neoadjuvant chemotherapy (NAC) improves overall survival by 5-8% in current meta-analyses. Adjuvant chemotherapy (AC) has shown benefit but is less rigorously tested. Methods: We retrospectively reviewed the cystectomy database at our institute from 2005-2011 and analyzed patients who have received NAC or AC for MIBC. The Log rank test was used to compare survival between groups and Cox regression models were used for adjusted comparisons of survival. Results: 45 patients (p) (13 NAC and 32 AC) were evaluated with a mean age of 65.5 years (50-82), including 77% males and 23% females. Patients were most commonly offered chemotherapy because of co-morbidities and performance status. NAC was most commonly gemcitabine (G)/cisplatin (n=9) and AC was usually G/platinum (n=27). Sixty-nine percent of patients were downstaged and 23% had a complete pathologic response following NAC. Three p in AC group had positive margins; all of these cases were T4 cancers. Pathologic staging showed 84% ≥T3 and 53% node positive disease. Patients receiving AC had a mean interval of 64.8 days (42-129) to the start of treatment. NAC and AC patients received median 4.1 (3-7) and 4.5 cycles (1-12), respectively, throughout entire course of treatment. The median overall survival (OS) was 24.5 months (m) (17.1 m-not reached) and 24-month survival rate was 47%. Progression free survival (PFS) was 12.3 m (8.5-23.5 m) for all patients. There was no difference for OS or PFS based on age, gender, time after surgery to first dose of therapy, or mode of therapy (NAC or AC). When adjusted for number of cycles completed, a trend toward improved median OS (not reached vs. 22 m p= 0.092 ) and a significant PFS improvement (28.5 vs 11.5 m p=0.026) with NAC vs. AC was observed. Grade 3-4 urologic toxicity was negligible in both groups, however the AC group had a higher percentage of grade 3-4 hematologic toxicity. Conclusions: Despite a small sample size, results from our series favor NAC based upon efficacy and tolerability for patients with locally invasive bladder cancer.

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