Relationship of Systemic Immune-Inflammation Index and Neutrophil-Lymphocyte ratio with Disease Recurrence and Progression risk in Non-Muscle-Invasive Bladder Cancer

Objective: Some systemic inflammatory response-based biomarkers are promising for predicting prognosis of non-muscle-invasive bladder cancer (NMIBC) patients and can contribute to the risk classification without any significant cost. We aimed to evaluate the neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) for the prediction of recurrence and progression risk in patients with NMIBC. Material and Methods: The study included a retrospective analysis of 211 patients who underwent transurethral resection of bladder (TURB) in a tertiary referral center between 2015 and 2019. The receiver operating characteristic (ROC) curve was used to determine the cut-off value. The Kaplan-Meier curves and the log-rank test were constructed to evaluate the recurrence-free and progression-free survival rates according to different levels of inflammatory markers. The multivariate regression analysis was undertaken to estimate the independent prognostic factors. Results: The optimal cut-off value of SII was found to be 568 in the ROC analysis. According to the multivariate analysis, the SII value, number of tumors at the time of initial TURB, and European Organization for Research and Treatment of Cancer (EORTC) recurrence classification were statistically significant parameters in predicting recurrence. While tumor size, NLR, and SII achieved statistically significant levels in the univariate analysis, they didn’t have significance in the multivariate analysis. Conclusion: The SII, number of tumors, and EORTC recurrence classification are prognostic parameters that can be used in the assessment of recurrence. However, inflammatory parameters do not have the same predictive ability in the prediction of the progression rate.