Effects of neoadjuvant novel endocrine therapy combined with prostatic artery embolization on SII, PNI, and bRFS in patients with prostate cancer.

OBJECTIVE

To investigate the effects of neoadjuvant novel endocrine therapy combined with prostatic artery embolization (PAE) on systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and biochemical recurrence-free survival (bRFS) in patients with high-risk or locally advanced prostate cancer, and to evaluate the feasibility of SII/PNI as early prognostic biomarkers.

METHODS

A retrospective analysis was conducted on 339 patients treated between Feb 2019 and Mar 2023, including 174 patients in the combination group (endocrine therapy + PAE) and 165 in the control group (endocrine therapy alone). PSA50/PSA90 response rates, surgical conversion rate, and changes in SII and PNI at 1 and 3 months after treatment were compared between the two groups. Kaplan-Meier analysis was used to evaluate bRFS, and time-dependent receiver operating characteristic (ROC) curves were applied to assess the predictive value of SII and PNI for 1- and 2-year bRFS.

RESULTS

The combination group demonstrated significantly higher PSA50/PSA90 response rates (P<0.05), higher surgical conversion rate (66.7% vs. 42.4%, P<0.001), greater reductions in SII (≥30%: 83.3% vs. 64.2%), and more pronounced PNI improvement (≥45: 82.9% vs. 69.7%, P<0.01) compared with the control group. The 1- and 2-year bRFS rates increased by 8.4% and 11.2%, respectively (P<0.05). SII and PNI measured at 3 months showed good predictive performance for bRFS, with AUC values ranging from 0.73 to 0.83. Survival analysis based on SII/PNI stratification revealed significant differences between groups (P<0.05).

CONCLUSION

The combined regimen accelerates PSA reduction, improves surgical feasibility, and alleviates systemic inflammation and nutritional status. SII/PNI detection at 3 months may facilitate early identification of recurrence risk and guide individualized treatment adjustment.