Impact of preoperative systemic immune-inflammation Index on oncologic outcomes in bladder cancer patients treated with radical cystectomy

Nico C. Grossmann, Victor M. Schuettfort, Benjamin Pradere, Pawel Rajwa, Fahad Quhal, Hadi Mostafaei, Ekaterina Laukhtina, Keiichiro Mori, Reza S. Motlagh, Abdulmajeed Aydh, Satoshi Katayama, Marco Moschini, Christian D. Fankhauser, Thomas Hermanns, Mohammad Abufaraj, Dong Ho Mun, Kristin Zimmermann, Harun Fajkovic, Martin Haydter, Shahrokh F. Shariat

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Purpose: To investigate the predictive and prognostic value of the preoperative systemic immune-inflammation index (SII) in patients undergoing radical cystectomy (RC) for clinically non-metastatic urothelial cancer of the bladder (UCB). Methods: Overall, 4,335 patients were included, and the cohort was stratified in two groups according to SII using an optimal cut-off determined by the Youden index. Uni- and multivariable logistic and Cox regression analyses were performed, and the discriminatory ability by adding SII to a reference model based on available clinicopathologic variables was assessed by area under receiver operating characteristics curves (AUC) and concordance-indices. The additional clinical net-benefit was assessed using decision curve analysis (DCA). Results: High SII was observed in 1879 (43%) patients. On multivariable preoperative logistic regression, high SII was associated with lymph node involvement (LNI; P = 0.004), pT3/4 disease (P <0.001), and non-organ confined disease (NOCD; P <0.001) with improvement of AUCs for predicting LNI (P = 0.01) and pT3/4 disease (P = 0.01). On multivariable Cox regression including preoperative available clinicopathologic values, high SII was associated with recurrence-free survival (P = 0.028), cancer-specific survival (P = 0.005), and overall survival (P = 0.006), without improvement of concordance-indices. On DCAs, the inclusion of SII did not meaningfully improve the net-benefit for clinical decision-making in all models. Conclusion: High preoperative SII is independently associated with pathologic features of aggressive disease and worse survival outcomes. However, it did not improve the discriminatory margin of a prediction model beyond established clinicopathologic features and failed to add clinical benefit for decision making. The implementation of SII as a part of a panel of biomarkers in future studies might improve decision-making.

Original languageEnglish
Pages (from-to)106.e11-106.e19
JournalUrologic Oncology: Seminars and Original Investigations
Issue number3
Publication statusPublished - Mar 2022


  • Biomarkers
  • Inflammation, Prognosis
  • SII
  • Transitional cell carcinoma
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Oncology
  • Urology


Dive into the research topics of 'Impact of preoperative systemic immune-inflammation Index on oncologic outcomes in bladder cancer patients treated with radical cystectomy'. Together they form a unique fingerprint.

Cite this