Preoperative Systemic Immune-Inflammation Index In Predicting Biochemical Recurrence After Radical Prostatectomy: A Clinical Study

Objective:The aim of this study was to investigate the clinical significance and prognostic value of the preoperative Systemic Immune-inflammation Index(SII)in predicting Biochemical Recurrence(BCR)after Radical Prostatectomy(RP)for Prostate Cancer(PCa).Method:In this study,clinical data were collected from 403 patients with PCa who underwent RP in the Department of Urology,Second Affiliated Hospital of Nanchang University between 06/2017 and 06/2022.Draw Receiver Operating Characteristic(ROC)curves for Neutrophil Lymphocyte Ratio(NLR),Platelet Lymphocyte Ratio(PLR),and SII,and identify the optimal cutoff value through the maximum Jordan index.Pearson chi-square test or Fisher’s exact test was used to explore the relationship between preoperative NLR,PLR and SII with other clinicopathological variables.Survival curves were plotted using the Kaplan-Meier method,and the Log-rank test was used to analyze the differences between survival curves.Cox proportional risk models were used to perform univariate and multifactorial regression analyses of prognostic factors to identify independent prognostic indicators.Result:The mean age of patients included in this study was 68.39±6.17 years(53-81years),with a median follow-up time of 15 months(range:1-62 months),and 13patients developed BCR.The occurrence of BCR after radical surgery in PCa patients is the follow-up endpoint,and the ROC curve is plotted.The optimal cutoff value for predicting BCR by preoperative SII,NLR,and PLR is 731×10~9,3.41,and 140.68.Kaplan Meier survival analysis showed that the preoperative high NLR,PLR,and SII groups had lower rates of no biochemical recurrence(P<0.001).Single factor COX proportional risk model analysis showed preoperative PSA>20ng/ml(HR=5.484,95%CI 1.160-25.923,P=0.032),incisional margin(HR=10.373,95%CI 3.321-32.404,P<0.001),vascular nerve invasion(HR=3.426,95%CI 1.027-11.430,P=0.045),pathological staging(HR=4.212,95%CI 1.334-13.293,P=0.014),NLR(HR=16.231,95%CI 2.109-124.932,P=0.007),SII(HR=120.357,95%CI 1.067-13574.403,P=0.047)is a predictive factor for postoperative BCR in PCa patients undergoing radical surgery.Multivariate COX regression analysis was conducted on the significant predictive factors among single factors,and the results showed that the margin condition(HR=11.842,95%CI 2.514-55.774,P=0.002)was a significant independent predictor of postoperative BCR in PCa patients.Conclusion:Preoperative NLR and SII can be used as simple prognostic indicators for BCR after radical surgery in PCa patients,and preoperative PLR is not a prognostic indicator for BCR after radical surgery in PCa patients.PCa patients with high levels of inflammatory markers SII and NLR may be more likely to develop BCR.