PRETREATMENT SYSTEMIC IMMUNE-INFLAMMATORY INDEX FOR A PROGNOSTIC IMPACT IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER TREATED WITH CONCURRENT CHEMORADIOTHERAPY

Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand

Problem statement: The systemic immune-inflammation index (SII) has been considered a prognosticator of survival outcomes in various types of solid cancer. Recent studies have shown that SII correlated with poor survival outcomes in early-stage cervical cancer. However, the evidence of the prognostic significance of SII was limited in cervical cancer patients with advanced stage. We, therefore, conducted this study to evaluate SII as a prognostic impact in patients diagnosed with locally advanced cervical cancer treated with concurrent chemoradiotherapy.

Methods: A retrospective cohort of 426 patients diagnosed with cervical cancer stage IIB-IVA receiving concurrent chemoradiation in our institute from 2012 to 2021 were evaluated. Patients were categorized into two groups; primary cohort and validation cohort. The impact of SII and potential prognostic factors on overall survival (OS) and progression-free survival (PFS) were examined. A prognostic nomogram to predict survival and its validation were performed.

Results: Higher values of SII were associated with poorer PFS and OS in univariate Cox analysis. Among all hematological indices, SII was only an independent prognostic factor for survivals. In multivariate analysis, the factors independently impacting OS in primary cohort were SII ≥ 475 (HR 2.15 ,95% CI 1.13,4.09), the larger tumor size (HR 1.1, 95% CI 1.04-1.17), poor ECOG score (HR 4.82, 95% CI 0.48-48.66), and the presence of metastatic lymph nodes (HR 2.53, 95% CI 1.41-4.56). Also in the validation cohort, high SII resulted in poor survival outcomes. High SII was associated with shorter PFS in both cohorts. The nomogram integrating SII could predict 3-year and 5-year survivals with good crimination ability. These results were consistent across the validation cohort.

Conclusions: Increased values of SII result in poor OS and PFS in locally advanced cervical cancer. SII can be used as a new independent prognostic factor and could enable clinicians to more accurately estimate the survival of patients.