Abstract

Objective: To investigate the predictive value of the systemic inflammation score (SIS) for adverse pathology (AP) and biochemical recurrence (BCR) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP), and further develop and validate predictive nomograms based on SIS.
Background: The SIS based on serum albumin (ALB) level and lymphocyte to monocyte ratio (LMR), has been verified as a potential biomarker in several types of cancers. However, its impact on the AP and prognosis of PCa remains unclear.
Methods: A retrospective analysis was conducted on 516 PCa patients who underwent RP in our institution from 2010 to 2020. The enrolled patients were randomly divided into a training cohort (n=361) and a validation cohort (n=155) in a 7:3 ratio. The nomograms based on SIS were established according to independent predictors identified by multivariate Cox and logistic regression analyses.
Results: In the training cohort, the multivariate Cox regression analysis demonstrated that SIS, platelet-lymphocyte ratio (PLR), percentage of positive biopsy cores (PPC) and postoperative prostate‐specific antigen (PSA) nadir were independent predictors for BCRFS. The multivariate logistic regression analysis demonstrated that SIS, ALB, PSA and PPC were independent predictors for high-grade (HG), while SIS, PSA density (PSAD) and PPC were independent predictors for lymph node metastasis (LNM). The C-indexes of the nomograms for predicting BCRFS, HG and LNM were 0.731 (95% CI=0.677-0.785), 0.811 (95% CI=0.766-0.855), 0.817 (95%CI=0.764-0.870) in the training cohort and 0.732 (95% CI=0.634-0.830), 0.845 (95% CI=0.785-0.905) and 0.867 (95%CI=0.808-0.926) in the validation cohort. The calibration curves and decision curve analysis further confirmed the reliability and clinical applicability of the nomograms in both training and validation cohorts.
Conclusion: The SIS is significantly associated with BCRFS, HG and LNM in PCa patients treated with RP, which could serve as a promising and powerful biomarker.

Keywords

Prostate cancer, radical prostatectomy, systemic inflammation score, adverse pathology, biochemical recurrence