Department of Oncology, University of Calgary, Calgary, AB, Canada.
Department of Oncology, University of Calgary, Calgary, AB, Canada.
Gynecol Oncol. 2024 Nov;190:291-297. doi: 10.1016/j.ygyno.2024.09.005. Epub 2024 Sep 12.
Systemic immune, inflammatory, and nutritional indices are prognostic across multiple tumor sites. Comprehensive analysis of these markers in patients with locally advanced cervical cancer (LACC) treated with definitive (chemo)radiotherapy [(C)RT] is limited and may assist with future prognostication.
For this retrospective cohort study, patients with LACC treated with definitive (C)RT were identified from a comprehensive cancer center's clinicopathological database. Pre-treatment indices were derived including systemic immune-inflammation index (SII), platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), albumin to alkaline phosphatase ratio (AAPR) and prognostic nutritional index (PNI). Univariate analysis was performed for PFS and OS. ROC curves were analyzed to determine optimal cut points. PFS and OS were assessed by the Kaplan-Meier method and Log-Rank test. Multivariate analysis was performed using Cox regression.
196 patients were identified: median follow-up 7 years (IQR 2-11). Higher SII (≤700 vs >700; p = 0.01), higher PLR (≤ 250 vs >250; p < 0.001) and higher NLR (≤ 5 vs >5; p = 0.003) were associated with worse PFS. Higher SII (≤700 vs >700: p = 0.02), higher PLR (≤ 250 vs >250: p < 0.001) and higher NLR (≤ 5 vs >5; p = 0.01) were associated with worse OS. On multivariate analysis, SII, NLR and PLR were independently associated with PFS. SII and PLR were independently associated with OS.
SII and PLR were independently associated with PFS and OS in patients with LACC treated with definitive (C)RT. NLR was independently associated with PFS. High inflammatory state is associated with shorter survival suggesting this as a target for interventions if validated in future studies.
全身免疫、炎症和营养指标在多种肿瘤部位具有预后价值。对接受根治性（放）化疗（C）RT 治疗的局部晚期宫颈癌（LACC）患者进行这些标志物的综合分析受到限制，可能有助于未来的预后判断。
本回顾性队列研究从综合癌症中心的临床病理数据库中确定了接受根治性（C）RT 治疗的 LACC 患者。提取治疗前指标，包括全身免疫炎症指数（SII）、血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、白蛋白与碱性磷酸酶比值（AAPR）和预后营养指数（PNI）。进行单因素分析以评估 PFS 和 OS。通过 ROC 曲线分析确定最佳切点。通过 Kaplan-Meier 方法和 Log-Rank 检验评估 PFS 和 OS。采用 Cox 回归进行多因素分析。
共确定了 196 例患者：中位随访 7 年（IQR 2-11）。较高的 SII（≤700 比>700；p=0.01）、较高的 PLR（≤250 比>250；p<0.001）和较高的 NLR（≤5 比>5；p=0.003）与较差的 PFS 相关。较高的 SII（≤700 比>700：p=0.02）、较高的 PLR（≤250 比>250：p<0.001）和较高的 NLR（≤5 比>5；p=0.01）与较差的 OS 相关。多因素分析显示，SII、NLR 和 PLR 与 PFS 独立相关。SII 和 PLR 与 OS 独立相关。
在接受根治性（C）RT 治疗的 LACC 患者中，SII 和 PLR 与 PFS 和 OS 独立相关。NLR 与 PFS 独立相关。高炎症状态与较短的生存期相关，这表明如果在未来的研究中得到验证，这可能是干预的目标。
