Predictive Value of Pre-treatment Hematological Parameters for Response to Definitive Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Study

Abstract

Background: More than 90% of cervical cancers are related to chronic inflammation caused by HPV. Several studies have shown that laboratory hematological parameters can detect the severity of systemic inflammation. Objectives: Our current cohort study investigated the predictive role of pretreatment hematological parameters for response to definitive chemoradiotherapy in patients with locally advanced cervical cancer (LACC). Methods: Prospectively, patients with LACC who candidates for definitive chemoradiation at Shohadaye Haftom-e-Tir are and Firozgar Hospitals (Tehran, Iran) were included in our study between April 2021 and December 2022. Hematological parameters were obtained from the blood sample test and peripheral blood smear before treatment. All patients diagnosed in stage IB to IVA received a similar treatment protocol and follow-up. Patients were divided into complete clinical (CR) and non-complete clinical responses (Non-CR). Leukocyte, Lymphocyte, neutrophil, platelet, hemoglobin (Hb), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), were documented and then compared between two groups of responders. We used receiver operating characteristic (ROC) analysis to investigate the predictive value of these hematological parameters. Results: Out of 34 patients who met the inclusion criteria, 25 (73/5%) patients were complete responders and 9 (26.5%) were non-complete responders. The average number of neutrophils, leukocytes, and NLR was significantly higher among Non-complete responders. Hemoglobin in patients with non-complete responses was significantly lower than that of the other group of responders. Receiver operating characteristic curve analysis showed that the optimized cut-off values for pretreatment Hb and NLR were 11 and 2.1, respectively. Neutrophil-to-lymphocyte ratio cut-off point > 2.1 is significantly associated with larger tumor size, low Hb, high platelet, and high leukocyte. Conclusions: hematological markers such as NLR can be a simple and inexpensive predictive factor to evaluate therapeutic response to chemoradiation in LACC patients.