Prognostic Value of Body Composition and Systemic Inflammatory Markers in Patients with Locally Advanced Cervical Cancer Following Chemoradiotherapy

Abstract

Background: Abnormal changes in body composition and systemic inflammation response have been associated with poor survival of cancer patients. Our study was to explore the prognostic value of the association between body composition indicators and systemic inflammation markers among patients with locally advanced cervical cancer (LACC) who underwent concurrent chemoradiotherapy (CCRT). Methods: We retrospectively reviewed medical records of LACC patients treated between 2016 and 2019. Subcutaneous, visceral and intra-muscular adipose index (SAI, VAI and IMAI) and skeletal muscle index (SMI) were derived from computed tomography (CT). Kaplan-Meier analysis and Univariate and multivariate Cox analyses were used to evaluate the survival. A nomogram was constructed to assess the prognostic value. Results:The study included 196 patients treated with CCRT. According to multivariable Cox analyses, IIIC1r (P = 0.045), high systemic immune-inflammation index (SII) (P = 0.004), sarcopenia (P = 0.008), high SAI (P = 0.016) and high VAI (P = 0.001) were significantly risk factors for overall survival (OS). Kaplan-Meier analysis showed that patients with low lymphocyte-to-monocyte ratio (LMR) and sarcopenia had longer OS than those with high LMR and sarcopenia (P = 0.023). The high neutrophil-to-lymphocyte ratio (NLR) in non-sarcopenic patients showed better survival (P = 0.022). Low VAI (P = 0.019) or low IMAI (P = 0.019) combined with low SII had a favorable OS. Low LMR combined with low SAI was associated with longer OS (P = 0.022). The calibration plots of nomogram predicting the 3-year and 5-year OS rates were close to the ideal models. Conclusion: Inflammation factors were closely associated with abnormal muscle and fat distribution. The combined prognostic value of body composition indicators and systemic inflammation markers was reliable in predicting survival for LACC patients.

Association of body composition and systemic inflammation for patients with locally advanced cervical cancer following concurrent chemoradiotherapy

“…20 Cumulative evidence has indicated a significant association between the SII and survival in cervical cancer. 16,21,22 In this study, it was found that a higher SII was independently associated with poorer OS and PFS. These findings can be attributed to the prognostic value of each SII component.…”

“…[30][31][32] Similarly, the prognostic value of adiposity in patients with LACC re-mains controversial. 9,22 We speculated that considering individual muscle or fat parameters alone might not accurately describe the distribution of body composition, which could weaken the prognostic prediction ability. Therefore, we investigated the combined index of muscle and fat areas, vFMR, and confirmed its prognostic value.…”

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

“…Guo et al [30] conducted an analysis including 196 LACC patients treated with concurrent CRT (Paclitaxel and Cisplatin), and the authors took into account the prognostic value of body composition and systemic inflammatory markers, which is also an SII. Among the other factors, this marker was significantly associated with OS (p = 0.004) in a multivariable model, with a cut-off value of ≥1377.37.…”