Who is Next? Impact of Systemic Immune-Inflammation Index and De Ritis Ratio for Predicting 90-Day Survival after...

Salvage cystectomy (SC) following failed bladder-preserving therapy shows an association with exceptionally high perioperative morbidity and mortality. Reliable preoperative biomarkers that can predict short-term outcomes are urgently needed. We investigated whether the systemic immune-inflammation index (SII) and De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) can serve as predictors of 90-day postoperative survival following SC.

Of the 139 patients with advanced bladder cancer (cT3b-cT4) who underwent cystectomy between 2010 and 2025 at a tertiary referral centre, we identified 70 individuals who underwent SC. We then aimed to create a matched control group from a pool of primary radical cystectomy (RC) patients. With the use of a nearest-neighbour matching approach based on age, sex and clinical stage, a suitable match was found for 69 of the 70 SC patients. Therefore, the final study cohort consisted of 70 SC patients and 69 primary RC patients. The groups were well-balanced for the matching variables. Preoperative clinical, pathological and laboratory variables-including SII and De Ritis ratio-were assessed. The primary endpoint was 90-day all-cause mortality, and statistical significance was defined as p < 0.05.

The 90-day mortality rate reached 49.6%. Nonsurvivors had significantly higher preoperative SII (979.9 vs. 521.5, p < 0.001) and De Ritis ratios (1.52 vs. 1.24, p < 0.001) compared with the survivors. Multivariate analyses confirmed SII (p < 0.001) and De Ritis ratio (p = 0.018) as independent predictors of early mortality. Receiver operating characteristic analysis demonstrated good discrimination with SII (area under the curve (AUC): 0.79) and De Ritis ratio (AUC: 0.68). The combined model demonstrated the highest predictive performance (AUC: 0.80; Sensitivity 69.6%; Specificity 80.0%).

Elevated preoperative SII and De Ritis ratio can independently predict 90-day mortality following SC. Their combined use may improve prognostic accuracy and offer a cost-effective and readily available tool for preoperative risk stratification in this high-risk population.