Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_17_3483 - Prognostic Value and Kinetics of Neutrophil to Lymphocyte Ratio Prior to and During Definitive Chemoradiotherapy for Intact Cervical Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Prognostic Value and Kinetics of Neutrophil to Lymphocyte Ratio Prior to and During Definitive Chemoradiotherapy for Intact Cervical Cancer
N. D. Prionas1, C. R. Nwachukwu2, R. Von Eyben2, N. Sandhu1, and E. A. Kidd1; 1Stanford Cancer Institute, Stanford, CA, 2Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA

Purpose/Objective(s): The ratio of circulating neutrophils and lymphocytes (NLR), a marker of systemic inflammation, prior to definitive treatment of cervical cancer (CC) is prognostic of recurrence and overall survival (OS). Most prior studies evaluated NLR at a single time point prior to therapy. It remains unclear if changes in NLR during treatment can be used as a biomarker to predict patient outcome and guide therapy. The purpose of this study was to validate the prognostic value of pretreatment NLR and evaluate the predictive value of NLR changes during treatment.

Materials/Methods: Under institutional review board approval, we retrospectively reviewed the charts of 108 cervix patients treated with definitive chemoradiotherapy. The prognostic value of baseline NLR (bNLR) for recurrence and death was evaluated by cumulative incidence analysis and Kaplan Meier analysis (above/below median), respectively, and by Cox proportional hazard regression. Continuous NLR through treatment (cNLR) was modeled using a fixed-effects repeated measures model and compared between groups by chemotherapy agents delivered (cisplatin vs cisplatin + 5-fluorouracil), percent of intended cycles delivered (<100% vs ≥ 100%), radiotherapy field (pelvic vs pelvic + para-aortic), recurrence, and death. Single- and multiple-variable generalized mixed models were used to evaluate cNLR as a predictor of recurrence and OS.

Results: Median follow-up was 25.5 months with 32 recurrences and 22 deaths. High bNLR (>3.45) was associated with higher cumulative incidence of recurrence (42.5% vs 27.4% at 45 months, p=0.13) and decreased median OS (81 months vs median not reached, p=0.04). In Cox proportional hazard models, bNLR was prognostic of recurrence (HR 1.13, 95% CI 0.99-1.29, p=0.08) and death (HR 1.20, 95% CI 1.03-1.41, p=0.02). cNLR increased during chemoradiotherapy, peaking near mid-treatment; cNLR was consistently higher in patients who received cisplatin + 5-FU (p<0.01), underwent pelvic + para-aortic radiotherapy (p<0.01), recurred (p=0.02), or died (p<0.01). cNLR was not predictive of recurrence or death in generalized mixed models. Chemotherapy type, percent of cycles delivered, and radiotherapy field were not predictive of recurrence or OS.

Conclusion: bNLR is prognostic of overall survival and recurrence. During treatment, cNLR increases to peak levels near mid-treatment and is consistently higher in patients undergoing more aggressive treatment (multi-agent chemotherapy, large radiotherapy field) and with poor outcome (recurrence or death). While monitoring hematologic markers during treatment is critical to minimize toxicity, the cNLR does not add predictive value for recurrence and survival beyond the prognostic value of bNLR.

Author Disclosure: N.D. Prionas: None. C.R. Nwachukwu: None. N. Sandhu: None. E.A. Kidd: Research Grant; Siemen's.

Nicolas Prionas, MD, PhD

Stanford Health Care-Sponsored Stanford University

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