Comparison of PIV and Other Immune Inflammation Markers of Oncological and Survival Outcomes in Patients Undergoing Radical Cystectomy.

Simple Summary: Although considerable progress has been made in the management of high-risk and muscle-invasive bladder neoplasm in terms of new therapeutic techniques and new chemo/radiotherapy treatments, it remains a high-mortality tumor, with about 50% of patients developing distant metastasis. The outlook following radical cystectomy is contingent on histological traits like staging and grading of the tumor, metastatic condition, involvement of lymphatic nodes, histological variant, or lymph vascular invasion and vascular infiltration. It would be advisable to develop a prognostic model and preoperative risk stratification for those patients most at risk who might need further treatment after surgery. Although much research has been conducted on the use of blood biomarkers to improve the follow-up for these patients, there is still much confusion about this, and no biomarker is standard in the clinical setting. Our retrospective research aimed to examine the prospective added value of the pan-immune inflammation value (PIV) index and other known predictive factors and compare them with other inflammation indices for the oncological outcomes of patients treated with radical cystectomy (RC). Inflammation is widely acknowledged as a significant characteristic of cancer, playing a substantial function in both the initiation and advancement of cancers. In this research, we planned to compare pan-immune inflammation markers and other well-known markers (systemic immune inflammation index and neutrophil to lymphocyte ratio) to predict prognosis in individuals treated with radical cystectomy for bladder cancer. Methods: In this retrospective analysis, we focused on preoperative PIV, systemic immune inflammation index (SII), and neutrophil–lymphocyte ratio (NLR) in 193 individuals managed with radical cystectomy for bladder cancer between January 2016 and November 2022. Multivariable logistic regression assessments were performed to assess the predictive capabilities of PIV, SII, and NLR for infiltration of lymph nodes (N), aggressive tumor stage (pT3/pT4), and any non-organ limited disease at the time of RC. Multivariable Cox regression analyses were conducted to assess the predictive impact of PIV on Relapse-free survival (RFS), Cancer-specific survival (CSS), and Overall survival (OS). Results: Our individuals were divided into high PIV and low PIV cohorts using the optimal cut-off value (340.96 × 10⁹/L) based on receiver operating characteristic curve analysis for relapse-free survival. In multivariable preoperative logistic regression models, only SII and PIV correlated with the infiltration of lymph nodes, aggressive disease, and any non-organ confined disease. In multivariable Cox regression models considering presurgical clinicopathological variables, a higher PIV was associated with diminished RFS (p = 0.017) and OS (p = 0.029). In addition, in multivariable Cox regression models for postoperative outcomes, a high PIV correlated with both RFS (p = 0.034) and OS (p = 0.048). Conclusions: Our study suggests that PIV and SII are two very similar markers that may serve as independent and significant predictors of aggressive disease and worse survival impacts on individuals undergoing radical cystectomy for bladder neoplasm. [ABSTRACT FROM AUTHOR]