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PD15-09 PROGNOSTIC VALUE OF SYSTEMIC INFLAMMATION INDICES IN RADICAL CYSTECTOMY: A COMPREHENSIVE ANALYSIS OF SII AND NLR
Abstract   Peer reviewed

PD15-09 PROGNOSTIC VALUE OF SYSTEMIC INFLAMMATION INDICES IN RADICAL CYSTECTOMY: A COMPREHENSIVE ANALYSIS OF SII AND NLR

Ekamjit S. Deol, Chloe Shi, Grant Henning, Spyridon Basourakos, Matthew Tollefson, Robert Tarrell, Prabin Thapa, Vidit Sharma, Robert J. Karnes, Stephen A. Boorjian, …
The Journal of urology, Vol.215(5S), p.e866
05/2026
DOI: 10.1097/01.JU.0001191528.11208.bf.09

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Abstract

INTRODUCTION AND OBJECTIVES: Urothelial carcinoma (UC) is among the most immunogenic urologic malignancies. Several prognostic indices have been proposed to provide insight into the status of an individual’s immune system at the time of surgery, including the Systemic Immune-Inflammation Index (SII) and the Neutrophil-to-Lymphocyte Ratio (NLR). We aim to compare the prognostic value of pre-op SII versus NLR for post-operative outcomes following radical cystectomy (RC). METHODS: We queried our prospectively maintained institutional registry for patients who underwent RC for UC from 2000-2022. Patients with at least two preoperative complete blood counts with differential were included. Patients were excluded if they had prior immunotherapy or comorbidities affecting the immune system. SII and NLR were analyzed as single preoperative values and temporal trends over time (categorized as uptrending, downtrending, or stable). Multivariable Cox regression models were constructed to explore associations with post-operative outcomes. RESULTS: The cohort included 738 patients with a median age of 70 years and median follow-up of 4.5 years after cystectomy. On multivariable survival analyses, higher preoperative SII and NLR values were significantly associated with worse overall survival (SII: p<0.001, NLR: p=0.002) and worse cancer-specific survival (SII: p<0.001, NLR: p=0.003) [Figure 1]. Temporal changes in pre-operative SII and NLR were not significantly associated with post-operative outcomes. CONCLUSIONS: Higher pre-operative SII and NLR values are independently associated with worse long-term oncologic outcomes among patients undergoing RC. SII and NLR may aid in pre-operative risk stratification before cystectomy, serve as potential biomarkers for clinical trials, and help guide patient selection for adjuvant systemic therapy after RC. Notably, both SII and NLR are readily accessible as part of routine pre-operative bloodwork, thus facilitating seamless integration of these prognostic biomarkers into routine clinical practice.

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