Classical Prognostic Factors Predict Prognosis Better than Inflammatory Indices in Locally Advanced Cervical Cancer: Results of a Comprehensive Observational Study including Tumor-, Patient-, and Treatment-Related Data (ESTHER Study)

Abstract

Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical cancer (LACC) including patient-, tumor-, and treatment-related potential prognostic factors. All patients underwent definitive chemoradiation and pretreatment values of several inflammatory indices (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, systemic immune inflammation index (SII), leukocyte/lymphocyte ratio, combination of platelet count and NLR, aspartate aminotransferase/platelet ratio index, aspartate aminotransferase/lymphocyte ratio index, systemic inflammatory response index, and aspartate transaminase/neutrophil ratio index) were calculated. Their correlation with local control (LC), distant metastasis-free (DMFS), disease-free (DFS), and overall survival (OS) was analyzed. One hundred and seventy-three patients were included. At multivariable analysis significant correlations were recorded among clinical outcomes and older age, advanced FIGO stage, lower hemoglobin levels, larger tumor size, and higher body mass index values. The multivariate analysis showed only the significant correlation between higher SII values and lower DMFS rates (p < 0.01). Our analysis showed no significant correlation between indices and DSF or OS. Further studies are needed to clarify the role of inflammation indices as candidates for inclusion in predictive models in this clinical setting.

Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study—AFRAID Project)

“…Furthermore, understanding the dynamics of SO and its response to interventions within the context of LACC treatment could inform the development of predictive models. These models could incorporate SO along with other potential prognostic factors, such as indices of systemic inflammation [ 22 , 23 ], results from functional imaging [ 40 ], radiomic indices [ 41 , 42 , 43 ], and results of liquid biopsies [ 44 , 45 ]. By comprehensively assessing how these factors interact and influence treatment outcomes, we may move closer to achieving more accurate prognostication and personalized treatment strategies for LACC patients.…”

“…Patients received definitive CRT with pelvic external beam RT (45–50 Gy in 1.8–2 Gy fractions) and intracavitary BRT (80–90 Gy for the gross tumor volume). The clinical target volume included relevant areas with specific expansions, as previously described [ 22 , 23 ]. Patient alignment was monitored daily with imaging devices [ 24 ].…”

“…Follow-up included physical exams every three months for the first two years, followed by six-month intervals for three years. Computed tomography scans were performed as needed or every six months in the first two years and annually thereafter [22,23]. In this analysis, we included patient-related factors such as age and hemoglobin (Hb) levels (measured in g/100 mL).…”

The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy

“…Ferioli et al [29] presented the results of the ESTHER study. The aim of their research was to correlate the prognostic impact in LACCs of different pre-treatment nutritional and systemic inflammation indices, such as SII, on the following clinical endpoints: local control (LC), distant metastasis free survival (DMFS), DFS, and OS.…”

Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study)

“…BRT was administered to all patients, with a median dose of 37 Gy for pulsed-dose-rate BRT (ranging from 23 to 39 Gy) and 28 Gy for high-dose-rate BRT (ranging from 4 to 42 Gy). [30]).…”