A total of 376 UTUC patients were included in the present study (Table 1). There were 146 (38.8%) male patients and 230 (61.2%) female patients. Female were dominant in our study cohort. The mean age was 65.9 ± 10.8 years. The mean follow-up time after surgery was 108.6 ± 39.7 months. Moreover, 101 patients (26.8%) had bladder cancer history, 146 patients (38.8%) had pathologic pTa/pTis/pT1 stage, 68 (23.4%) had pT2 stage, 114 (30.3%) pT3 stage, and 28 (7.4%) had pT4 stage. ROC analysis revealed that the optimal cut-off values of SII, NLR, and PLR for MFS and CSS were 460, 3.5, and 162 and 485, 2.9, and 150, respectively. The cut-off values of BRFS were 490, 3.5, and 160. Table 1 using the CSS cut-off values shows that an elevated SII was associated with bladder cancer history, advanced pathologic tumor stage, lymph node invasion, and adjuvant chemotherapy; high NLR was associated with older age, hemodialysis status, anemia, multifocal tumor, advanced pathologic tumor stage, and adjuvant chemotherapy; and high PLR was associated with older age, anemia, advanced pathologic tumor stage, and adjuvant chemotherapy. These three inflammatory indexes were closely linked to each other.
Table 1
Associations of NLR, PLR, SII and clinicopathologic characteristics in 376 patients treated with radical nephroureterectomy for upper tract urothelial carcinoma.
Parameters
|
All
|
NLR
|
PLR
|
SII
|
|
> 2.9
|
≤ 2.9
|
p-value
|
> 150
|
≤ 150
|
p-value
|
> 485
|
≤ 485
|
p-value
|
|
n(%)
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
Age
|
|
|
0.006
|
|
|
< 0.001
|
|
|
0.972
|
≤ 70
|
208(55.3)
|
70(46.7)
|
138(61.1)
|
|
28(35.9)
|
180(60.4)
|
|
116(55.2)
|
92(55.4)
|
|
> 70
|
168(44.7)
|
80(53.1)
|
88(38.9)
|
|
50(64.2)
|
118(39.6)
|
|
94(44.8)
|
74(44.6)
|
|
Gender
|
|
|
|
0.214
|
|
|
0.263
|
|
|
0.601
|
Male
|
146(38.8)
|
64(42.7)
|
82(36.3)
|
|
26(33.3)
|
120(40.3)
|
|
84(40.0)
|
62(37.3)
|
|
Female
|
230(61.2)
|
86(57.3)
|
144(63.7)
|
|
52(66.7)
|
178(59.7)
|
|
126(60.0)
|
104(62.7)
|
|
Smoking
|
|
|
|
0.182
|
|
|
0.175
|
|
|
0.104
|
No
|
308(81.9)
|
118(78.7)
|
190(84.1)
|
|
68(87.2)
|
240(80.5)
|
|
166(79.0)
|
142(85.5)
|
|
Yes
|
68(18.1)
|
32(21.3)
|
36(15.9)
|
|
10(12.8)
|
58(19.5)
|
|
44(21.0)
|
24(14.5)
|
|
Bladder cancer history
|
|
|
|
0.263
|
|
|
0.989
|
|
|
0.025
|
No
|
275(73.1)
|
105(70.0)
|
170(75.2)
|
|
57(73.1)
|
218(73.2)
|
|
144(68.6)
|
131(78.9)
|
|
Yes
|
101(26.9)
|
45(30.0)
|
56(24.8)
|
|
21(26.9)
|
80(26.8)
|
|
66(31.4)
|
35(21.1)
|
|
BMI
|
|
|
|
0.056
|
|
|
0.096
|
|
|
0.462
|
>27
|
62(16.5)
|
18(12.0)
|
44(19.5)
|
|
8(10.3)
|
54(18.1)
|
|
32(15.2)
|
30(18.1)
|
|
≤27
|
314(83.5)
|
132(88.0)
|
182(80.5)
|
|
70(89.7)
|
244(81.9)
|
|
178(84.8)
|
136(81.9)
|
|
ESRD
|
|
|
|
0.044
|
|
|
0.479
|
|
|
0.151
|
No
|
300(79.8)
|
112(74.7)
|
188(83.2)
|
|
60(76.9)
|
240(80.5)
|
|
162(77.1)
|
138(83.1)
|
|
Yes
|
76(20.2)
|
38(25.3)
|
38(16.8)
|
|
18(23.1)
|
58(19.5)
|
|
48(22.9)
|
28(16.9)
|
|
Anemia
|
|
|
|
0.016
|
|
|
< 0.001
|
|
|
0.127
|
No
|
138(36.7)
|
44(29.3)
|
94(41.6)
|
|
14(17.9)
|
124(41.6)
|
|
70(33.3)
|
68(41.0)
|
|
Yes
|
238(63.3)
|
106(70.7)
|
132(58.4)
|
|
64(82.1)
|
174(58.4)
|
|
140(66.7)
|
98(59.0)
|
|
ECOG score
|
|
|
|
0.156
|
|
|
0.290
|
|
|
0.080
|
0, 1
|
297(79.0)
|
113(75.3)
|
184(81.4)
|
|
65(83.3)
|
232(77.9)
|
|
159(75.7)
|
138(83.1)
|
|
2, 3
|
79(21.0)
|
37(24.7)
|
42(18.6)
|
|
13(16.7)
|
66(22.1)
|
|
51(24.3)
|
28(16.9)
|
|
CKD stage
|
|
|
|
0.053
|
|
|
0.223
|
|
|
0.699
|
Stage 1
|
36(9.6)
|
6(4.0)
|
30(13.3)
|
|
4(5.1)
|
32(10.7)
|
|
18(8.6)
|
18(10.8)
|
|
Stage 2
|
78(20.7)
|
32(21.3)
|
46(20.4)
|
|
18(23.1)
|
60(20.1)
|
|
44(21.0)
|
34(20.5)
|
|
Stage 3
|
154(41.0)
|
64(42.7)
|
90(39.8)
|
|
28(35.9)
|
126(42.3)
|
|
84(40.0)
|
70(42.2)
|
|
Stage 4
|
24(6.4)
|
10(6.7)
|
14(6.2)
|
|
8(10.3)
|
16(5.4)
|
|
12(5.7)
|
12(7.2)
|
|
Stage 5
|
84(22.3)
|
38(25.3)
|
46(20.4)
|
|
20(25.6)
|
64(21.5)
|
|
52(24.8)
|
32(19.3)
|
|
Advanced CKD stage (Stage 4, 5)
|
108(28.7)
|
48(32.0)
|
60(26.5)
|
0.253
|
28(35.9)
|
80(26.8)
|
0.116
|
64(30.5)
|
44(26.5)
|
0.398
|
Type of operation
|
|
|
|
0.304
|
|
|
0.712
|
|
|
0.093
|
Open
|
244(64.9)
|
48(32.0)
|
84(37.2)
|
|
52(66.7)
|
192(66.4)
|
|
144(68.6)
|
100(60.2)
|
|
Laparoscopic
|
132(35.1)
|
102(68.0)
|
142(62.8)
|
|
26(33.3)
|
106(35.6)
|
|
66(31.4)
|
66(39.8)
|
|
Tumor location
|
|
|
|
0.910
|
|
|
0.131
|
|
|
0.445
|
Pyelocaliceal
|
170(45.2)
|
68(45.3)
|
102(45.1)
|
|
42(53.8)
|
128(43.0)
|
|
98(46.7)
|
72(43.4)
|
|
Ureteral
|
132(35.1)
|
54(36.0)
|
78(34.5)
|
|
26(33.3)
|
106(35.6)
|
|
68(32.4)
|
64(38.6)
|
|
Both
|
74(19.7)
|
28(18.7)
|
46(20.4)
|
|
10(12.8)
|
64(21.5)
|
|
44(21.0)
|
30(18.1)
|
|
Multifocality
|
|
|
|
0.021
|
|
|
0.568
|
|
|
0.099
|
Single
|
298(79.3)
|
110(73.3)
|
188(83.2)
|
|
60(76.9)
|
238(79.9)
|
|
160(76.2)
|
138(83.1)
|
|
Multiple
|
78(20.7)
|
40(26.7)
|
38(16.8)
|
|
18(23.1)
|
60(20.1)
|
|
50(23.8)
|
28(16.9)
|
|
Pathologic T stage
|
|
|
|
0.001
|
|
|
0.018
|
|
|
0.017
|
pTa/pTis/pT1
|
146(38.8)
|
46(30.7)
|
100(44.2)
|
|
26(33.3)
|
120(40.3)
|
|
70(33.3)
|
76(45.8)
|
|
pT2
|
68(23.4)
|
38(25.3)
|
50(22.1)
|
|
20(25.6)
|
68(22.8)
|
|
52(24.8)
|
36(21.7)
|
|
pT3
|
114(30.3)
|
46(30.7)
|
68(30.1)
|
|
20(25.6)
|
94(31.5)
|
|
66(31.4)
|
48(28.9)
|
|
pT4
|
28(7.4)
|
20(13.3)
|
8(3.5)
|
|
12(15.4)
|
16(5.4)
|
|
22(10.5)
|
6(3.6)
|
|
Advanced pT stage (pT3, pT4)
|
|
|
|
0.042
|
|
|
0.505
|
|
|
0.063
|
No
|
234(62.2)
|
84(56.0)
|
150(66.4)
|
|
46(59.0)
|
188(63.1)
|
|
122(58.1)
|
112(67.5)
|
|
Yes
|
142(37.8)
|
66(44.0)
|
76(33.6)
|
|
32(41.0)
|
110(36.9)
|
|
88(41.9)
|
54(32.5)
|
|
Pathologic N stage
|
|
|
|
0.659
|
|
|
0.479
|
|
|
0.003
|
pN0
|
68(18.1)
|
23(15.3)
|
36(15.9)
|
|
22(22.4)
|
42(14.1)
|
|
31(14.8)
|
35(21.1)
|
|
pNx
|
232(61.7)
|
95(63.3)
|
146(64.6)
|
|
58(59.2)
|
198(66.4)
|
|
125(59.5)
|
109(65.7)
|
|
pN+
|
76(20.2)
|
32(21.3)
|
44(19.5)
|
|
18(23.1)
|
58(19.5)
|
|
54(25.7)
|
22(13.3)
|
|
Grade
|
|
|
|
0.257
|
|
|
0.941
|
|
|
0.527
|
Low
|
76(20.2)
|
26(17.3)
|
50(22.1)
|
|
16(20.5)
|
60(20.1)
|
|
40(19.0)
|
36(21.7)
|
|
High
|
300(79.8)
|
124(82.7)
|
176(77.9)
|
|
62(79.5)
|
238(79.9)
|
|
170(81.0)
|
130(78.3)
|
|
Adjuvant chemotherapy
|
|
|
|
0.015
|
|
|
0.009
|
|
|
< 0.001
|
No
|
308(81.9)
|
114(76.0)
|
194(85.8)
|
|
56(71.8)
|
252(84.6)
|
|
158(75.2)
|
150(90.4)
|
|
Yes
|
68(18.1)
|
36(24.0)
|
32(14.2)
|
|
22(28.2)
|
46(15.4)
|
|
52(24.8)
|
16(9.6)
|
|
NLR
|
|
|
|
|
|
|
< 0.001
|
|
|
< 0.001
|
>2.9
|
-
|
-
|
-
|
|
76(97.4)
|
74(24.8)
|
|
140(66.7)
|
10(6.0)
|
|
≤2.9
|
-
|
-
|
-
|
|
2(2.6)
|
224(75.2)
|
|
70(33.3)
|
156(94.0)
|
|
PLR
|
|
|
|
< 0.001
|
|
|
|
|
|
< 0.001
|
>150
|
78(20.7)
|
76(50.7)
|
2(0.9)
|
|
-
|
-
|
|
78(37.1)
|
0(0.0)
|
|
≤150
|
298(79.3)
|
74(49.3)
|
224(99.1)
|
|
-
|
-
|
|
132(62.9)
|
166(100.0)
|
|
SII
|
|
|
|
< 0.001
|
|
|
< 0.001
|
|
|
|
>485
|
210(55.9)
|
140(93.3)
|
70(31.0)
|
|
78(100.0)
|
132(44.3)
|
|
-
|
-
|
|
≤485
|
166(44.1)
|
10(6.7)
|
156(69.0)
|
|
0(0.0)
|
166(55.7)
|
|
-
|
-
|
|
CKD chronic kidney disease; ECOG Eastern Cooperative Oncology Group; ESRD end stage renal disease; NLR neutrophile-lymphocyte ratio; PLR Platelet-lymphocyte ratio; SII systemic immune-inflammation index
|
Kaplan–Meier analysis for MFS, CSS, and BRFS
Ninety-four patients (25.0%) from our study cohort experienced metastasis events (female, 58 patients; male, 36 patients). The 3- and 5-year MFS rates were 76.6% and 71.8%, respectively. Univariate analysis showed that bladder cancer history (p = 0.004), advanced CKD stage (p = 0.004), ureteral tumors (p = 0.029), advanced pathological stage (p < 0.001), multifocal tumor (p = 0.013) lymph node invasion (p < 0.001), high tumor grade (p < 0.001), adjuvant chemotherapy (p < 0.001), elevated NLR (p < 0.001), elevated PLR (p < 0.001), and elevated SII (p < 0.001) were associated with worse MFS (Table 2). Ureteral tumors (p = 0.019), advanced pathological tumor stage (p < 0.001), high tumor grade (p = 0.039), adjuvant chemotherapy (p < 0.001), elevated NLR (p = 0.021), elevated PLR (p = 0.009), and elevated SII (p = 0.004) were independent risk factors for lower MFS in multivariate analysis. The Kaplan–Meier analysis indicated that patients exhibiting higher NLR, PLR, and SII showed significantly poor MFS rates (Figs. 1a, 1b, and 1c; log-rank, all P < 0.001).
Table 2
Univariate and multivariate analyses predicting CSS, MFS and BRFS in patients (n = 376) with UTUC after RNU
Parameters
|
MFS
|
CSS
|
BRFS
|
|
Univariate
Analysis
|
p
|
Multivariate
analysis
|
p
|
Univariate
analysis
|
p
|
Multivariate
analysis
|
p
|
Univariate
analysis
|
p
|
Multivariate
analysis
|
p
|
|
HR(95%CI)
|
|
HR(95%CI)
|
|
HR(95%CI)
|
|
HR(95%CI)
|
|
HR(95%CI)
|
|
HR(95%CI)
|
|
Age (Years)
|
|
|
|
|
|
|
|
|
|
|
|
|
Over 70 years
|
1.1(0.7–1.8)
|
0.632
|
|
|
1.3(0.7–2.2)
|
0.366
|
|
|
1.2(0.8–1.9)
|
0.391
|
|
|
Gender
|
|
|
|
|
|
|
|
|
|
|
|
|
Male vs Female
|
1.0(0.9–1.2)
|
0.509
|
|
|
1.2(0.9–1.6)
|
0.329
|
|
|
2.2(1.4–3.4)
|
0.001
|
2.4(1.5-4.0)
|
0.001
|
Smoking
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
1.3(0.8–2.1)
|
0.352
|
|
|
1.2(0.6–2.3)
|
0.674
|
|
|
1.2(0.7–2.2)
|
0.465
|
|
|
Bladder cancer history
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
1.3(1.1–1.5)
|
0.004
|
1.2(0.9–1.4)
|
0.586
|
1.2(0.9–1.5)
|
0.126
|
|
|
1.8(1.5–2.1)
|
< 0.001
|
1.6(1.4–1.9)
|
< 0.001
|
BMI (Kg/m2)
|
|
|
|
|
|
|
|
|
|
|
|
|
Over 27 Kg/m2
|
1.7(0.9-3.0)
|
0.078
|
|
|
2.8(1.0-7.3)
|
0.025
|
6.1(1.7–21.1)
|
0.005
|
1.1(0.7–1.8)
|
0.579
|
|
|
ESRD
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
1.4(0.9–2.4)
|
0.138
|
|
|
1.0(0.6–1.8)
|
0.964
|
|
|
1.6(0.9–2.7)
|
0.080
|
|
|
Anemia
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
1.1(0.7–1.5)
|
0.711
|
|
|
1.0(0.6–1.8)
|
0.995
|
|
|
1.2(0.9–1.8)
|
0.132
|
|
|
ECOG
|
|
|
|
|
|
|
|
|
|
|
|
|
2, 3 vs 0, 1
|
1.5(0.9–2.6)
|
0.125
|
|
|
1.5(0.8–2.8)
|
0.241
|
|
|
1.2(0.7-2.0)
|
0.518
|
|
|
CKD stage
|
|
|
|
|
|
|
|
|
|
|
|
|
Stage 2 vs Stage 0,1
|
3.9(0.4–34.1)
|
0.199
|
|
|
1.1(0.4–3.4)
|
0.890
|
|
|
1.4(0.5–3.5)
|
0.500
|
|
|
Stage 3 vs Stage 0,1
|
4.1(0.5–34.7)
|
0.167
|
|
|
2.4(0.8–7.4)
|
0.104
|
|
|
1.4(0.6–3.3)
|
0.442
|
|
|
Stage 4 vs Stage 0,1
|
6.9(0.7–71.7)
|
0.083
|
|
|
1.6(0.4–7.1)
|
0.535
|
|
|
1.2(0.3–3.9)
|
0.803
|
|
|
Stage 5 vs Stage 0,1
|
1.1(0.1–13.7)
|
0.960
|
|
|
1.2(0.4–3.6)
|
0.791
|
|
|
1.8(0.7–4.3)
|
0.224
|
|
|
Advanced CKD (Stage 4, 5)
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
2.0(1.2–3.2)
|
0.004
|
1.2(0.5–2.7)
|
0.686
|
1.6(0.9–2.9)
|
0.103
|
|
|
1.2(0.7-2.0)
|
0.453
|
|
|
Type of operation
|
|
|
|
|
|
|
|
|
|
|
|
|
Laparoscopic vs open
|
0.9(0.6–1.5)
|
0.803
|
|
|
0.6(0.3–1.2)
|
0.135
|
|
|
0.7(0.4–1.1)
|
0.158
|
|
|
Tumor location
|
|
|
|
|
|
|
|
|
|
|
|
|
Ureteral vs Pyelocaliceal
|
2.5(1.1–5.7)
|
0.029
|
4.2(1.3–13.7)
|
0.019
|
1.2(0.7–2.3)
|
0.058
|
|
|
1.0(0.6–1.7)
|
0.967
|
|
|
Both vs Ureteral
|
1.5(0.5–4.4)
|
0.318
|
1.2(0.6–2.6)
|
0.211
|
1.2(0.6–2.5)
|
0.683
|
|
|
1.4(0.8–2.7)
|
0.238
|
|
|
Both vs Pyelocaliceal
|
1.6(0.6–4.2)
|
0.430
|
2.8(0.8-9.0)
|
0.095
|
1.4(0.7–2.9)
|
0.342
|
|
|
1.5(0.8–2.6)
|
0.204
|
|
|
Multifocality
|
|
|
|
|
|
|
|
|
|
|
|
|
Multiple vs Single
|
2.0(1.2–3.4)
|
0.013
|
1.6(0.7–3.9)
|
0.285
|
1.5(0.8–2.8)
|
0.217
|
|
|
1.1(0.7–1.9)
|
0.654
|
|
|
Pathologic T stage
|
|
|
|
|
|
|
|
|
|
|
|
|
pT2 vs pTa/pTis/pT1
|
3.0(1.3-7.0)
|
0.008
|
1.2(0.2–6.8)
|
0.185
|
1.7(0.6–4.8)
|
0.289
|
1.4(0.4–4.1)
|
0.593
|
1.0(0.6–1.7)
|
0.924
|
1.2(0.6–2.2)
|
0.683
|
pT3 vs pTa/pTis/pT1
|
12.2(5.8–25.7)
|
< 0.001
|
1.8(0.9–3.5)
|
0.177
|
7.3(3.2–16.6)
|
< 0.001
|
2.2(1.4–3.5)
|
0.001
|
1.1(0.6–1.8)
|
0.803
|
1.4(0.9–2.1)
|
0.133
|
pT4 vs pTa/pTis/pT1
|
13.6(5.1–36.3)
|
< 0.001
|
2.6(1.5–4.7)
|
< 0.001
|
9.6(3.3–27.4)
|
< 0.001
|
1.6(1.1–2.4)
|
0.032
|
4.2(1.1–16.4)
|
0.011
|
1.8(1.1–3.2)
|
0.032
|
Pathologic N stage
|
|
|
|
|
|
|
|
|
|
|
|
|
pN + vs pN0/pNx
|
3.8(2.2–6.4)
|
< 0.001
|
1.2(0.5–2.9)
|
0.640
|
2.3(1.3–4.3)
|
0.006
|
1.3(0.6-3.0)
|
0.467
|
1.1(0.7–1.7)
|
0.604
|
|
|
Grade
|
|
|
|
|
|
|
|
|
|
|
|
|
High vs Low
|
5.7(2.2–15.0)
|
< 0.001
|
4.4(1.1–17.9)
|
0.039
|
2.3(1.3–4.2)
|
0.032
|
1.1(0.4–3.6)
|
0.830
|
1.9(1.1–3.1)
|
0.020
|
2.5(1.4–4.4)
|
0.010
|
Adjuvant chemotherapy
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
43.8(20.6–93.3)
|
< 0.001
|
40.7(16.3-101.7)
|
< 0.001
|
8.9(4.8–16.4)
|
< 0.001
|
6.6(3.2–13.7)
|
< 0.001
|
4.3(2.5–7.4)
|
< 0.001
|
4.8(2.7–8.5)
|
< 0.001
|
Post-operative installation chemotherapy
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes vs No
|
0.9(0.8–1.2)
|
0.785
|
|
|
1.0(0.6–1.3)
|
0.788
|
|
|
1.1(1.0-1.2)
|
0.028
|
1.0(0.9–1.1)
|
0.678
|
NLR
|
(> 3.5 vs ≤ 3.5)
|
|
|
|
(> 2.9 vs ≤ 2.9)
|
|
|
|
(> 3.5 vs ≤ 3.5)
|
|
|
|
|
2.3(1.4–3.7)
|
< 0.001
|
2.2(1.1–4.3)
|
0.021
|
2.7(1.5–4.7)
|
< 0.001
|
2.3(1.2–4.3))
|
0.009
|
1.3(0.8-2.0)
|
0.253
|
|
|
PLR
|
(> 162 vs ≤ 162)
|
|
|
|
(> 150 vs ≤ 150)
|
|
|
|
(> 160 vs ≤ 160)
|
|
|
|
|
3.1(1.8–5.2)
|
< 0.001
|
3.6(1.4–9.4)
|
0.009
|
2.2(1.2–4.1)
|
0.009
|
2.0(1.1-4.0)
|
0.046
|
1.0(0.7–1.5)
|
0.910
|
|
|
SII
|
(> 460 vs ≤ 460)
|
|
|
|
(> 485 vs ≤ 485)
|
|
|
|
(> 490 vs ≤ 490)
|
|
|
|
|
3.4(2.0-5.8)
|
< 0.001
|
2.9(1.4–6.1)
|
0.004
|
3.8(2.0-7.4)
|
< 0.001
|
3.3(1.3–8.5)
|
0.014
|
1.7(1.1–2.7)
|
0.026
|
1.7(1.1–2.8)
|
0.016
|
CKD chronic kidney disease; ECOG Eastern Cooperative Oncology Group; ESRD end stage renal disease; NLR neutrophile-lymphocyte ratio; PLR Platelet-lymphocyte ratio; SII systemic immune-inflammation index
|
Sixty patients (15.9%) had cancer-specific mortality during follow-up (female, 38 patients; male, 22 patients). The 3- and 5-year CSS rates were 84.1% and 79.2%, respectively. Univariate analysis showed that obesity (p = 0.025), advanced pathological stage (p < 0.001), lymph node invasion (p = 0.006), high tumor grade (p = 0.032), adjuvant chemotherapy (p < 0.001), elevated NLR (p < 0.001), elevated PLR (p = 0.009), and elevated SII (p < 0.001) were associated with worse CSS (Table 2). Obsity (p = 0.005), advanced pathological tumor stage (p < 0.001), adjuvant chemotherapy (p < 0.001), elevated NLR (p = 0.009), elevated PLR (p = 0.046), and elevated SII (p = 0.014) were independent risk factors for lower CSS in multivariate analysis. Similarly, the Kaplan–Meier analysis revealed that patients exhibiting higher NLR, PLR, and SII showed significantly worse CSS rates (Figs. 2a, 2b, and 3c).
Additionally, 108 patients (28.7%) had bladder recurrence during follow-up (female, 52 patients; male, 56 patients). The 3- and 5-year BRFS rates were 78.6% and 63.5%, respectively. Univariate analysis showed that male gender (p = 0.001), bladder cancer history (p = 0.001), pT4 pathological stage (p = 0.011), high tumor grade (p = 0.020), adjuvant chemotherapy (p < 0.001), and elevated SII (p = 0.026) were associated with worse BRFS (Table 2). Male gender (p = 0.001), bladder cancer history (p < 0.001), pT4 pathological stage (p = 0.032), high tumor grade (p = 0.010), adjuvant chemotherapy (p < 0.001) and elevated SII (p = 0.016) were independent risk factors for lower BRFS in multivariate analysis. Adjuvant single postoperative instillations of chemotherapy after RNU can decrease the bladder recurrence rate in univariate analysis, but fail to achieve statistic difference in multivariate analysis. Further, the Kaplan–Meier analysis indicated that patients with higher SII showed significantly worse BRFS rates (Fig. 3c). Higher NLR and PLR were not associated with BRFS (Fig. 3a, and 3b).