The systemic inflammation response index: An independent predictive factor for survival outcomes of bladder cancer stronger than other inflammatory markers

We aimed to evaluate the prognostic value of the preoperative systemic inflammation response index (SIRI) to predict the outcomes after open radical cystectomy (RC).We conducted a retrospective analysis of the institutional cystectomy database and identified 241 consecutive RC patients. Patient demographics and oncologic outcomes were noted. We calculated the SIRI as previously described (NeutrophilxMonocytes/Lymphocytes), based on the blood-tests at the day before surgery and a minimum >30-day later.Median follow-up time was 20 months (interquartile range 9-52). Two, 3 and 5 years recurrence free (RFS) and overall survival (OS) rates were 60.6%, 57.1%, 48.9%, and 54.7%, 47.0%, 37.2%, respectively. Patients with preoperative SIRI >1.91 had significantly higher recurrence rates (P < 0.001) and lower OS (P < 0.001). For internal validation, we evaluated postoperative SIRI >1.91 (repeatability testing), and again found significantly higher recurrence rates (P < 0.001) and lower OS (P = 0.004). Persistently high SIRI increased the recurrence and death risk 5.79 and 2.87 fold, respectively. SIRI was also a significant independent predictive factor for RFS and OS in the multivariable cox regression analyses (P < 0.05). SIRI improved the discriminative ability of the models 1.5% to 4.2% and this was quite higher than other inflammatory markers (NLR, MLR, PLR, SII) in all models.Patients with SIRI >1.91 had significantly higher recurrence and lower OS rates. The cut-off value is validated internally. SIRI is an independent predictive factor for RFS and OS. The contribution of SIRI in the cox models is higher than other inflammatory markers.