Dynamics of Serum Inflammatory Markers Predict Survival After Definitive Chemoradiotherapy for Locally Advanced Cervical Cancer

Aim: Cervical cancer is caused by persistent infection with the human papillomavirus. This study aimed to investigate whether the changes in serum inflammatory markers between baseline and posttreatment can predict survival in cervical cancer undergoing definitive chemoradiotherapy (CCRT). Methods: Eighty-one Stage IB–IVA cervical cancer patients treated with definitive CCRT, with serum inflammatory markers obtained at diagnosis and after completion of pre-planned therapy, were included. The percent changes of post-/pretreatment levels × 100% were calculated for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII). The cutoffs were obtained with the maximal chi-square statistics. Results: At a median follow-up of 28 months, the 2-year overall survival (OS) was 75.4%. The 2-year OS for patients with low versus high percent change was as follows: post-/pre-NLR (87.7% vs. 67.8%), post-/pre-MLR (75.9% vs. 71.1%), post-/pre-SIRI (76.5% vs. 61.7%), and post-/pre-SII (91.7% vs. 67.2%) (all p < 0.05). The hazard ratios (HR) in multivariate analysis were as follows: post-/pre-NLR (5.53, 95% confidence interval [CI]: 1.65–18.52), post-/pre-MLR (3.39, 95% CI: 1.39–8.26), post-/pre-SIRI (5.11, 95% CI: 1.92–13.57), and post-/pre-SII (6.57, 95% CI: 1.77–24.36) (all p < 0.05). Conclusion: This study demonstrates the impact of the dynamics of serum inflammatory markers on survival. It has been consistently demonstrated across the markers. To adopt these markers for personalized treatment decisions, a better understanding of their relation with the actual tumor microenvironment is warranted.