Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Non-Metastatic Paediatric Wilms Tumour Patients Undergoing Upfront Radical Nephrectomy

Objective: To analyse the relationship between the preoperative systemic immune-inflammation index (SII) and the relapse-free survival (RFS) of paediatric patients with Wilms tumour (WT) after radical surgery, and to establish and validate a prognostic survival model. Study Design: Observational study. Place and Duration of the Study: Department of Oncologic Surgery, Anhui Children's Hospital of Fudan University, Hefei, China, from January 2013 to August 2023. Methodology: A retrospective analysis was conducted on 79 WT patients treated with radical resection, with their preoperative SII values computed. The best cut-off for SII was determined through the ROC curve, categorising patients into high and low SII groups. The Kaplan-Meier method and Cox-regression were used for survival analysis. A survival prognostic model was constructed and its predictive capability gauged (AUC of the ROC). Results: The study included 79 WT patients with a median RFS of 65 months and an average of 75.5 +/- 3.4 months. The optimal cutoff value for SII was 534.95. The low SII group had a higher RFS (Log-rank: chi(2) = 9.380, p = 0.002). Preoperative SII (HR = 3.277, 95% CI: 1.167- 9.200, p = 0.024), clinical staging (HR = 8.408, 95% CI: 2.604- 27.147, p <0.001), and tissue differentiation (HR = 2.237, 95% CI: 1.043- 5.828, p = 0.039) were independent risk factors for RFS. The model's diagnostic performance was 0.749 (95% CI: 0.636- 0.861). Internal validation showed an AUC of 0.723 (95% CI: 0.608- 0.838). Conclusion: Lower preoperative SII suggests a more favourable prognosis. The SII-based nomogram efficiently forecasts post-radical surgery prognosis for WT.