Selection and evaluation of preoperative systemic inflammatory response biomarkers model prior to cytoreductive nephrectomy using a machine-learning approach.

Abstract

INTRODUCTION:

This study aimed to determine the prognostic value of a panel of SIR-biomarkers, relative to standard clinicopathological variables, to improve mRCC patient selection for cytoreductive nephrectomy (CN).

MATERIAL AND METHODS:

A panel of preoperative SIR-biomarkers, including the albumin-globulin ratio (AGR), De Ritis ratio (DRR), and systemic immune-inflammation index (SII), was assessed in 613 patients treated with CN for mRCC. Patients were randomly divided into training and testing cohorts (65/35%). A machine learning-based variable selection approach (LASSO regression) was used for the fitting of the most informative, yet parsimonious multivariable models with respect to prognosis of cancer-specific survival (CSS). The discriminatory ability of the model was quantified using the C-index. After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net benefit.

RESULTS:

SIR-biomarkers were selected by the machine-learning process to be of high discriminatory power during the fitting of the model. Low AGR remained significantly associated with CSS in both training (HR 1.40, 95% CI 1.07-1.82, p = 0.01) and testing (HR 1.78, 95% CI 1.26-2.51, p = 0.01) cohorts. High levels of SII (HR 1.51, 95% CI 1.10-2.08, p = 0.01) and DRR (HR 1.41, 95% CI 1.01-1.96, p = 0.04) were associated with CSS only in the testing cohort. The exclusion of the SIR-biomarkers for the prognosis of CSS did not result in a significant decrease in C-index (- 0.9%) for the training cohort, while the exclusion of SIR-biomarkers led to a reduction in C-index in the testing cohort (- 5.8%). However, SIR-biomarkers only marginally increased the discriminatory ability of the respective model in comparison to the standard model.

CONCLUSION:

Despite the high discriminatory ability during the fitting of the model with machine-learning approach, the panel of readily available blood-based SIR-biomarkers failed to add a clinical benefit beyond the standard model.

• Authors: Ekaterina Laukhtina, Victor M Schuettfort, David D'Andrea, Benjamin Pradere, Fahad Quhal, Keiichiro Mori, Reza Sari Motlagh, Hadi Mostafaei, Satoshi Katayama, Nico C Grossmann, Pawel Rajwa, Pierre I Karakiewicz, Manuela Schmidinger, Harun Fajkovic, Dmitry Enikeev, Shahrokh F Shariat
• Journal: World journal of urology (World J Urol) Vol. 40 Issue 3 Pg. 747-754 (Mar 2022) ISSN: 1433-8726 [Electronic] Germany
• PMID: 34671856 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2021. The Author(s).

Chemical References

• Biomarkers

Topics

• Biomarkers
• Carcinoma, Renal Cell (pathology)
• Cytoreduction Surgical Procedures
• Humans
• Kidney Neoplasms (pathology)
• Machine Learning
• Nephrectomy (methods)
• Retrospective Studies
• Systemic Inflammatory Response Syndrome