# Pan-Immune-Inflammation Value as a Predictor of Long-Term Outcomes in Patients with Urothelial Carcinoma of the Bladder: A Pilot Study

## TL;DR

This study explores the pan-immune-inflammation value (PIV) as a potential biomarker for predicting bladder cancer progression and survival, finding it shows promise as a cost-effective tool.

## Contribution

The study introduces the pan-immune-inflammation value (PIV) as a novel blood-derived biomarker for bladder cancer prognosis.

## Key findings

- Elevated PIV levels were associated with faster disease progression and reduced survival in bladder cancer patients.
- PIV showed strong correlations with other inflammation indices like NLR, SII, SIRI, and PLR.
- High PIV was linked to shorter overall and progression-free survival in patients.

## Abstract

Bladder cancer presents with substantial heterogeneity, ranging from less aggressive non–muscle-invasive forms to more advanced muscle-invasive disease. The identification of simple and reliable prognostic markers is critical for optimizing treatment strategies. In this study, we investigated the prognostic relevance of the pan-immune-inflammation value (PIV), a blood-derived index reflecting systemic inflammation and immune status. A cohort of 119 patients with bladder cancer was analyzed, revealing that elevated PIV levels were associated with accelerated disease progression and reduced survival. Although PIV did not retain independent prognostic significance after adjustment for other variables, it demonstrated potential as a cost-effective and readily available tool for risk stratification. Validation in larger, prospective cohorts is warranted to establish its clinical applicability.

Background: Urothelial carcinoma of the bladder (UCB) demonstrates considerable heterogeneity, with markedly varying outcomes between non–muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). The pan-immune-inflammation value (PIV), derived from routine hematological parameters, has emerged as a novel biomarker reflecting systemic inflammation and immune dysregulation. This pilot, exploratory analysis evaluated the prognostic relevance of the PIV in UCB and contextualized PIV against other inflammation-based indices. Methods: We retrospectively analyzed 119 patients with histologically confirmed UCB who were treated between 2019 and 2024. PIV was calculated as (neutrophils × platelets × monocytes) ÷ lymphocytes. Additional indices included the NLR, SII, SIRI, and PLR. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier analysis, and prognostic factors were assessed using Cox regression. Results: Among 119 patients (median age, 72 years; 88% male), 68 were diagnosed with NMIBC and 51 with MIBC. Elevated PIV levels were significantly associated with NMIBC progression to MIBC (p = 0.028) and strongly correlated with NLR, SII, SIRI, and PLR. Patients with high PIV exhibited shorter OS (24 vs. 45 months) and PFS (20 vs. 35 months) than those with low patients (p < 0.001). Although the prognostic value was evident in the univariate analyses, PIV did not retain significance in multivariate models. Conclusion: Elevated PIV levels predict adverse survival outcomes and progression in UCB, underscoring its potential as a cost-effective and accessible biomarker for risk stratification. Prospective validation in larger cohorts is warranted to confirm its role in personalized patient management.