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Published on: September 15, 2023
Comparison of inflammation-based biomarkers in metastatic testicular cancer at initial diagnosis
Ibrahim Hacibey1, Eymen Ozer1, Berke Demiriz1
1Department of Urology, Basaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
Introduction:
This study evaluated the diagnostic accuracy of six systemic inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), for identifying metastatic disease at the initial diagnosis of testicular germ cell tumors (TGCTs).
Methods:
A total of 194 patients with histologically confirmed TGCTs treated between 2020 and 2025 were retrospectively analyzed. Pre-treatment complete blood counts were used to calculate inflammatory indices. Metastatic status was defined based on cross-sectional imaging, including contrast-enhanced chest, abdominal, and pelvic computed tomography. Associations with metastasis were assessed using Mann-Whitney U tests, univariate logistic regression, and receiver operating characteristic (ROC) analyses. Optimal cutoff values were determined by Youden's Index.
Results:
At initial diagnosis, a total of 194 patients were included, of whom 28 (14.4%) had imaging-confirmed metastatic disease. Patients with metastases exhibited significantly higher SII, SIRI, AISI, NLR, and PLR values and significantly lower LMR values compared with non-metastatic patients (all p<0.001). In pre-adjusted analyses, NLR (area under the curve [AUC] 0.781) and SIRI (AUC 0.755) demonstrated the strongest discriminatory performance for metastatic disease. ROC-derived cutoff values were 3.14 for NLR, 152.3 for PLR, 2.68 for LMR, 682.1 for SII, 2.84 for SIRI, and 1222.7 for AISI.
Conclusions:
Systemic inflammatory indices derived from routine blood counts are significantly associated with metastatic TGCTs at initial presentation. This study provides initial evidence supporting the potential clinical relevance of SIRI and AISI, alongside established markers such as NLR and SII, as complementary tools for early risk stratification. Prospective, multicenter studies are warranted to validate these findings.