Anemia, leukocytosis and thrombocytosis as prognostic factors in patients with cervical cancer treated with radical chemoradiotherapy: A retrospective cohort study

Abstract

IntroductionAnemia has long been associated with poor prognosis in patients with cervical cancer. Recently, additional hematologic parameters have emerged as potential indicators of worse outcome in this patient group. In a cohort of cervical cancer patients treated with chemoradiotherapy (CRT) and brachytherapy, we report on the prognostic significance of hematologic parameters including anemia, leukocytosis, neutrophil to lymphocyte ratio (NLR), and thrombocytosis, the effect of combining anemia with other hematologic parameters, and the effect of changes in hemoglobin levels during treatment.Materials and methodsTwo-hundred fifty-seven cervical cancer patients were retrospectively identified from a single cancer institution’s database. Hematologic parameters were categorized as: anemia (hemoglobin ≤115 g/L), leukocytosis (white blood cell count >10 × 109/L), thrombocytosis (platelets >400 × 109/L), and NLR (ratio >5). The association between clinical factors and hematologic parameters on progression-free survival (PFS) and overall survival (OS) were assessed at 5 years.ResultsAt 5 years, both pre-treatment anemia (PFS: 60% vs 34%, p < 0.0001; OS: 68% vs 41%, p < 0.0001) and on-treatment anemia (PFS: 62% vs 40%, p < 0.0001; OS: 70% vs 48%, p < 0.0001) were significantly associated with worse survival. This adverse effect on 5-year PFS and OS was increased in patients with both pre-treatment anemia and leukocytosis (PFS: 72% vs 42%, p < 0.0001; OS: 68% vs 37%, p < 0.0001) and pre-treatment anemia and elevated NLR (PFS: 61% vs 30%, p < 0.0001; OS: 68% vs 37%, p < 0.0001). Five-year PFS (50% vs 31%) and OS (60% vs 36%) was better in patients whose pre-treatment anemia improved to normal hemoglobin levels on treatment vs those patients who were anemic both pre- and on-treatment.ConclusionPre-treatment and on-treatment anemia were significant, independent predictors of worse PFS and OS. Anemia and other hematologic parameters remain prognostic markers for cervical cancer patients. Improvement in PFS and OS was seen in patients with normalization of hemoglobin.

Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer

“…The ROC curve analysis showed that, among these markers, the SII was more effective and accurate in predicting the outcomes of patients. Before our study, there are multiple papers that look at TRL and outcomes in cervical cancer 9–11,35,36 . TRL was indeed a risk factor for patients with cervical cancer.…”

Prognostic role of pretreatment thrombocytosis on survival in patients with cervical cancer: a systematic review and meta-analysis

“…Koulis et al indicated that pre-treatment and on-treatment anemia were correlated with worse survival. Moreover, an elevated platelet count was associated with poor OS in patients with various stages [34]. Kozasa et al reported pretreatment thrombocytosis and elevated platelet-lymphocyte ratio to be independent factors in patients with cervical cancer, and the prognostic role of platelet counts was more sensitive than that of the platelet-lymphocyte ratio [35].…”

Descriptive statistics of dataset from the meta-analysis and meta-regression analysis on prognostic significance of pre-treatment systemic hemato-immunological indices of cervical cancer patients

“…The basic data was collected by performing a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. In all, 9558 patients from 22 studies [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] were included in this analysis. The step-by-step search strategies are detailed in Table 1 .…”