University of Virginia Health Systems Charlottesville, VA
E. M. M. Janowski1, Y. Chavis1, R. Jin2, E. Hall2, B. Horton2, T. N. Showalter2, and K. Romano3; 1University of Virginia, Department of Radiation Oncology, Charlottesville, VA, 2University of Virginia, Charlottesville, VA, 3Department of Radiation Oncology, University of Virginia, Charlottesville, VA
Purpose/Objective(s): Circulating blood components have been shown to be predictive for cervical cancer outcomes, possibly serving as markers of systemic inflammation. This study evaluates the association between baseline neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and survival in women with locally advanced cervical cancer (LACC) treated with definitive chemoradiation (CRT), hypothesizing that elevated ratios correlate with worsened outcomes. Materials/
Methods: We retrospectively reviewed patients with LACC treated at a single institution from 2005 – 2021 with available neutrophil, lymphocyte, and platelet information. Patient and treatment characteristics were recorded including age, tumor size and stage, and radiation dosing. Neutrophil, lymphocyte, and platelet values were collected prior to initiating CRT, and NLR and PLR were calculated using a cutoff of = 3.5 and = 250 respectively. Overall survival (OS), progression free survival (PFS), and locoregional control (LRC) were calculated from the start of treatment to date of last follow-up using Kaplan-Meier analysis and cumulative incidence function. These metrics were compared between groups using the log-rank test and Gray’s test. Results: 124 patients met study inclusion criteria with stage IB – IV disease (41 stage I, 41 stage II, 36 stage III, 6 stage IV) and a median follow up of 3.6 years (range 0.2-16.5 years). The median age was 49 years (range 26-77). The median EBRT dose was 45 Gy (range: 26-57.5) and 44.2% of patients received para-aortic nodal EBRT. 5-year OS, PFS, and LRC were 60.3% (95% CI 51.5-70.7), 47.5% (95% CI 39-58), and 75.5% (95% CI 67.3-82.9), respectively. Baseline NLR of = 3.5 was present in 41 (33%) patients, and baseline PLR of = 250 was present in 28 (23%) patients. When the total cohort was divided into patients with and without elevated NLR and PLR ratios, OS was statistically improved in the patients without elevated ratios, with a 5-year OS of 70.9% (95% CI 60.7-82.8) versus 39.7% (95% CI 26.4-59.8) in the NLR group (p= 0.001) and 67.5% (95% CI 57.7-78.9) versus 36.7% (95% CI 21.9-61.5) in the PLR group (p= 0.001), respectively. Similarly, PFS was also statistically improved in the patients without elevated baseline ratios, with a 5-year PFS of 57.1% (95% CI 46.9-69.5) versus 30.7% (95% CI 19.0-49.7) in the NLR group (p= 0.009) and 52.2% (95% CI 42.4-64.2) versus 31.7% (95% CI 17.9-55.9) in the PLR group (p= 0.031), respectively. LRC was not different between the groups, 75.7% vs 75.0% (p=0.87) for NLR and 75.9% vs 74.0% (p=0.71) for PLR. Conclusion: In this single institution experience of LACC treated with definitive CRT, we found that baseline elevations in NLR and PLR correlated with worsened OS and PFS. While LRC remains robust in this patient population, these patients might benefit from systemic therapy intensification. Future studies are indicated to investigate the role of this hypothesis generating work.
