ESTRO 2023

Session Item

Gynaecological

Session Code: 6014

Session Type: Poster (Digital)

Track: Clinical

The role of inflammation markers in cervical cancers undergoing definitive chemoradiation

Ludovica Forlani, Italy

Presentation Number: PO-1432

Abstract

Abstract Title:

The role of inflammation markers in cervical cancers undergoing definitive chemoradiation

Authors:

Ludovica Forlani¹, Anna Benini¹, Viola Laghi¹, Federica Medici¹, Johnny Ma¹, Martina Ferioli¹, Claudio Malizia², Andrea Galuppi³, Gabriella Macchia⁴, Francesco Deodato⁴, Savino Cilla⁵, Milly Buwenge¹, Silvia Cammelli¹, Alessio Giuseppe Morganti¹, Alessandra Arcelli⁶

¹Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ²Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ³Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁴Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; ⁵Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; ⁶Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

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Purpose or Objective

Interest in radiotherapy (RT) about markers of systemic inflammation has spread due to their value in predicting outcomes in several tumors treated with RT. However, only few data are available on the impact of these markers in locally advanced cervical cancer (LACC) patients (pts). Moreover, in most studies, only one index with only a partial consideration of potential confounding factors was evaluated. Therefore, the aim of this study was to analyze a wide range of inflammation indices by including also other known prognostic factors.

Material and Methods

We retrospectively analyzed pts undergoing chemoradiation (ChRT) for LACC from July 2007 to July 2021. Pretreatment values of several indices were calculated: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), monocyte to lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and eosinophil to lymphocyte ratio (ELR). An univariate analysis (logrank test) on the impact of individual parameters on local control (LC), distant metastasis free survival (DMFS), disease free survival (DFS), and overall survival (OS), was performed. Furthermore, a multivariate Cox analysis on the same endpoints was performed including parameters significantly correlated with outcomes at univariate analysis.

Results

One hundred and seventy three patients were included in this analysis. The results of the univariate analysis are shown in Table 1. On univariate analysis no index of systemic inflammation was significantly correlated with DMFS, DFS, and OS, while a significant correlation with better OS rates was observed for patients with physiological BMI values, with less advanced FIGO stage, and with higher hemoglobin levels. Instead, on univariate analysis, NLR, PLR, SII, LMR, and MLR were significantly correlated to LC. However, on multivariate analysis, higher LC rates were significantly correlated only to higher hemoglobin levels (HR 0.57; 95% CI: 0.46-0.71, p<0.001).

Table I: Univariate analysis of overall survival, disease free survival, local control, and distant metastasis-free survival.

BMI: body mass index, cT stage: clinical tumor stage, cN stage: clinical nodal stage, International Federation of Gynecology and Obstetrics (FIGO) HB: hemoglobin. Statistically significant p-values are shown in bold

Conclusion

Our study suggests a limited role of systemic inflammation markers in predicting prognosis in LACC pts undergoing ChRT, while confirming the dramatically negative impact of anemia in this setting. However, further studies are underway to evaluate: i) the impact of inflammation markers assessed after ChRT; ii) the possible correlation between inflammation markers and sarcopenia and the predictive role of their combination in this setting.