The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer
<i>Background and Objectives</i>: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), plate...
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MDPI AG
2023-05-01
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| Online Access: | https://www.mdpi.com/1648-9144/59/5/926 |
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| author | Francesco Claps Giulio Rossin Bas W. G. van Rhijn Maria Carmen Mir Laura S. Mertens Luca Ongaro Fabio Traunero Alexandra I. Iachimovsky Andrea Piasentin Francesca Vedovo Alessandro Perotti Gabriele Tulone Alessandro Zucchi Giovanni Liguori Alchiede Simonato Riccardo Bartoletti Carlo Trombetta Nicola Pavan |
| author_facet | Francesco Claps Giulio Rossin Bas W. G. van Rhijn Maria Carmen Mir Laura S. Mertens Luca Ongaro Fabio Traunero Alexandra I. Iachimovsky Andrea Piasentin Francesca Vedovo Alessandro Perotti Gabriele Tulone Alessandro Zucchi Giovanni Liguori Alchiede Simonato Riccardo Bartoletti Carlo Trombetta Nicola Pavan |
| author_sort | Francesco Claps |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. <i>Materials and methods</i>: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. <i>Results</i>: The median age at RC was 73 yr (IQR 67–79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2–28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien–Dindo grade 1–2) while 100 (36.9%) experienced major complications (Clavien–Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15–4.90, <i>p</i> = 0.02), (OR 1.51, 95%CI 1.26–1.98, <i>p</i> = 0.09), and (OR 1.35, 95%CI 1.17–2.57, <i>p</i> = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15–4.16, <i>p</i> = 0.02; OR 2.18, 95%CI 1.13–4.44, <i>p</i> = 0.02, respectively). <i>Conclusions</i>: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions. |
| first_indexed | 2024-03-11T03:31:20Z |
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| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T03:31:20Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj.art-7335f674dcaf476c9321b176e1a1102c2023-11-18T02:22:24ZengMDPI AGMedicina1010-660X1648-91442023-05-0159592610.3390/medicina59050926The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder CancerFrancesco Claps0Giulio Rossin1Bas W. G. van Rhijn2Maria Carmen Mir3Laura S. Mertens4Luca Ongaro5Fabio Traunero6Alexandra I. Iachimovsky7Andrea Piasentin8Francesca Vedovo9Alessandro Perotti10Gabriele Tulone11Alessandro Zucchi12Giovanni Liguori13Alchiede Simonato14Riccardo Bartoletti15Carlo Trombetta16Nicola Pavan17Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyDepartment of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The NetherlandsDepartment of Urology, Hospital Universitario La Ribera, 46600 Valencia, SpainDepartment of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The NetherlandsUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyDepartment of Translational Research and New Technologies, University of Pisa, 56126 Pisa, ItalyUrology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, ItalyDepartment of Translational Research and New Technologies, University of Pisa, 56126 Pisa, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, ItalyDepartment of Translational Research and New Technologies, University of Pisa, 56126 Pisa, ItalyUrological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, ItalyUrology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy<i>Background and Objectives</i>: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. <i>Materials and methods</i>: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. <i>Results</i>: The median age at RC was 73 yr (IQR 67–79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2–28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien–Dindo grade 1–2) while 100 (36.9%) experienced major complications (Clavien–Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15–4.90, <i>p</i> = 0.02), (OR 1.51, 95%CI 1.26–1.98, <i>p</i> = 0.09), and (OR 1.35, 95%CI 1.17–2.57, <i>p</i> = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15–4.16, <i>p</i> = 0.02; OR 2.18, 95%CI 1.13–4.44, <i>p</i> = 0.02, respectively). <i>Conclusions</i>: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions.https://www.mdpi.com/1648-9144/59/5/926urinary bladder neoplasmsradical cystectomymorbiditypostoperative complicationsbiomarkers |
| spellingShingle | Francesco Claps Giulio Rossin Bas W. G. van Rhijn Maria Carmen Mir Laura S. Mertens Luca Ongaro Fabio Traunero Alexandra I. Iachimovsky Andrea Piasentin Francesca Vedovo Alessandro Perotti Gabriele Tulone Alessandro Zucchi Giovanni Liguori Alchiede Simonato Riccardo Bartoletti Carlo Trombetta Nicola Pavan The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer Medicina urinary bladder neoplasms radical cystectomy morbidity postoperative complications biomarkers |
| title | The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer |
| title_full | The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer |
| title_fullStr | The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer |
| title_full_unstemmed | The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer |
| title_short | The Utility of Inflammatory Serum Markers in the Assessment of Perioperative Morbidity after Radical Cystectomy for Bladder Cancer |
| title_sort | utility of inflammatory serum markers in the assessment of perioperative morbidity after radical cystectomy for bladder cancer |
| topic | urinary bladder neoplasms radical cystectomy morbidity postoperative complications biomarkers |
| url | https://www.mdpi.com/1648-9144/59/5/926 |
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