Systemic combining inflammatory score (SCIS): A new score for prediction of oncologic outcomes in patients with high-risk non-muscle-invasive urothelial bladder cancer

Matteo Ferro, Marina Di Mauro, Sebastiano Cimino, Giuseppe Morgia, Giuseppe Lucarelli, Abdal Rahman Abu Farhan, Mihai Dorin Vartolomei, Angelo Porreca, Francesco Cantiello, Rocco Damiano, Gian Maria Busetto, Francesco Del Giudice, Rodolfo Hurle, Sisto Perdonà, Marco Borghesi, Pierluigi Bove, Riccardo Autorino, Nicolae Crisan, Michele Marchioni, Luigi SchipsFrancesco Soria, Andrea Mari, Andrea Minervini, Alessandro Veccia, Michele Battaglia, Daniela Terracciano, Gennaro Musi, Giovanni Cordima, Matteo Muto, Vincenzo Mirone, Ottavio de Cobelli, Giorgio Ivan Russo

Research output: Contribution to journalArticlepeer-review


Background: An accurate and early diagnosis of bladder cancer (BC) is essential to offer patients the most appropriate treatment and the highest cure rate. For this reason, patients need to be best stratified by class and risk factors. We aimed to develop a score able to better predict cancer outcomes, using serum variables of inflammation. Methods: A total of 1,510 high-risk non-muscle invasive bladder cancer (NMIBC) patients were included in this retrospective observational study. Patients with pathologically proven T1 HG/G3 at first TURBT were included. Systemic combined inflammatory score (SCIS) was calculated according to systemic inflammatory markers (SIM), modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) dichotomized (final score from 0 to 3). Results: After 48 months of follow-up (IQR 40.0–73.0), 727 patients recurred (48.1%), 485 progressed (32.1%), 81 died for cancer (7.0%), and 163 died for overall causes (10.8%). Overall, 231 (15.3%) patients had concomitant Cis, 669 (44.3%) patients had multifocal pathology, 967 (64.1%) patients had tumor size >3 cm. Overall, 357 (23.6%) patients received immediate-intravesical therapy, 1,356 (89.8%) received adjuvant intravesical therapy, of which 1,382 (91.5%) received BCG, 266 (17.6%) patients received mitomycin C, 4 (0.5%) patients received others intravesical therapy. Higher SCIS was independently predictive of recurrence (hazard ratio HR 1.5, 1.3 and 2.2) and cancer specific mortality for SCIS 0 and 3 (HR: 1.61 and 2.3), and overall mortality for SCIS 0 and 3 (HR: 2.4 and 3.2). Conversely, SCIS was not associated with a higher probability of progression. Conclusions: The inclusion of the SCIS in clinical practice is simple to apply and can help improve the prediction of cancer outcomes. It can identify patients with high-grade BC who are more likely to experience disease mortality.

Original languageEnglish
Pages (from-to)626-635
Number of pages10
JournalTranslational Andrology and Urology
Issue number2
Publication statusPublished - Feb 2021


  • Bladder cancer (BC)
  • Immune system
  • Inflammation
  • Outcomes
  • Prognosis

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology


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