Association of Preoperative Pan-Immune-Inflammation Value with Adverse Pathology and Oncological Outcomes Following Radical Prostatectomy: A Single-Center Retrospective Study

Abstract

Background High Pan-Immune-Inflammation Value (PIV) has been associated with poorer survival outcomes in men with metastatic prostate cancer. However, whether PIV is associated with adverse pathology and long-term oncological outcomes in localized prostate cancer treated with radical prostatectomy (RP) remains unclear. Methods We retrospectively evaluated 808 men who underwent RP for prostate adenocarcinoma at Kaohsiung Medical University Hospital between 2012 and 2023; 442 met the eligibility criteria and were included in the final analysis. PIV was dichotomized using a Youden-derived cutpoint (153) based on subsequent androgen deprivation therapy (ADT), defined as any adjuvant or salvage ADT administered after RP. We used multivariable logistic and Cox regression models to evaluate associations between preoperative PIV and adverse pathological features, subsequent ADT, biochemical recurrence (BCR), metastasis-free survival (MFS), and overall survival (OS). Results Median follow-up was 65.8 months. During follow-up, 100 men (22.6%) received subsequent ADT, 71 (16.1%) developed metastasis or died, and 54 (12.2%) died. High PIV was independently associated with ≥pT3 disease (adjusted odds ratio [aOR] 1.79, 95% confidence interval [CI] 1.14-2.81; p = 0.012), subsequent ADT (adjusted hazard ratio [aHR] 2.18, 95% CI 1.32-3.60; p = 0.002), shorter MFS (aHR 2.37, 95% CI 1.29-4.35; p = 0.006), and shorter OS (aHR 3.12, 95% CI 1.46-6.67; p = 0.003), but not with BCR. Conclusions High preoperative PIV was independently associated with ≥pT3 disease, subsequent ADT, shorter MFS, and shorter OS after RP, but not with BCR. These findings suggest that PIV may reflect disease progression beyond PSA-defined recurrence and may serve as a complementary preoperative biomarker. Further validation in independent cohorts is required.