Evaluation of the relationship between inflammatory markers, prognostic nutritional index and prognosis in patients diagnosed with locally advanced cervical cancer receiving curative chemoradiotherapy

Cervical cancer is the fourth most common cancer among women worldwide. The most important risk factor is infection with the human papillomavirus (HPV). Vaccination against HPV strains with a higher likelihood of causing malignancy constitutes the main method of primary prevention. Patients staged between 1B3 and 4A are classified as having locally advanced cervical cancer. According to current European and international guidelines, the standard treatment for this group of patients is curative chemoradiotherapy followed by brachytherapy. Nutritional status and systemic inflammation are closely associated with cancer treatment outcomes. The Prognostic Nutritional Index (PNI), calculated using serum albumin levels and total lymphocyte count, is useful in predicting prognosis along with survival outcomes. In addition to lymphocyte count, other simple hematological markers such as neutrophil and platelet counts, as well as derived ratios including systemic inflammatory index (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), can be used as indirect indicators for detecting systemic inflammation. The aim of our study was to analyze the demographic characteristics, presenting symptoms, disease stages, pathology results, treatments received, progression-free survival (PFS), and overall survival (OS) of patients diagnosed with locally advanced cervical cancer who were followed and treated at the Trakya University Faculty of Medicine, Department of Medical Oncology, between 2013 and 2023, and to compare these findings with data in the literature. In this retrospective study, cases diagnosed with locally advanced cervical cancer who were treated with curative chemoradiotherapy and admitted to our clinic between January 2013 and January 2023 were evaluated. A total of 46 patient files with complete data were reviewed. Data were obtained from medical oncology archive records, the Trakya University Faculty of Medicine automation system, and patient files. Post-treatment PNI demonstrated significant prognostic value for both progression-free survival and overall survival. Patients with PNI >43.8 had longer PFS and OS. In addition, patients with pre-treatment SII ≤598.5 showed longer OS, while those with post-treatment SII ≤873.79 had longer PFS. Post-treatment NLR was also found to be associated with progression-free survival, and patients with NLR ≤3.83 had longer PFS. PLR showed no significant association with survival in either the pre-treatment or post-treatment period. Although post-treatment SII and post-treatment NLR were associated with progression-free survival in univariate analyses, neither was identified as an independent prognostic factor for progression-free survival in multivariate analyses. Similarly, although post-treatment PNI and pre-treatment SII were found to be associated with overall survival in univariate analyses, they were not identified as independent prognostic factors for overall survival in multivariate analyses. In conclusion, simple hematologic and nutritional parameters evaluated before and after treatment in locally advanced cervical cancer may provide important insights into prognosis. However, the independent prognostic value of these indicators needs to be validated in larger patient cohorts.