Impact of systemic inflammation biomarkers on the survival outcomes of cervical cancer patients

Inflammatory biomarkers have recently attracted attention as valuable prognosticators and predictors of survival outcomes in many cancers. We describe a new pre-treatment biomarker, expressed as the eosinophil–lymphocytes ratio (ELR) and validate other biomarkers such as the level of circulating eosinophils, neutrophil–lymphocytes ratio (NLR), platelet–lymphocytes ratio (PLR) and systemic immune-inflammatory index (SII) as prognostic factors in cervical cancer (CC) patients. A retrospective cohort of 151 consecutive patients diagnosed with CC and treated according to the European guidelines with radiotherapy and/or chemotherapy and/or surgery in our institution from 2009 to 2016 were evaluated. Patients were categorized into two different groups based on the optimal cut-off for each biomarker, according to the receiver operating characteristic (ROC) curves. Impact of blood biomarkers on overall survival (OS), cancer-specific survival (CCS) and progression-free survival (PFS) were examined. Higher values of ELR, eosinophils and age ≥ 50 years were associated with better OS in univariate Cox analysis, while high NLR, PLR, SII, neutrophils ≥ 7.0, Bulky tumor and FIGO stage III–IV at diagnosis were prognosticators of worse survival outcomes. In multivariate analysis, the only factors independently impacting OS were ELR ≥ 0.07 (HR = 0.49, p = 0.048) and FIGO stage III–IV (HR = 2.5, p = 0.018). High PLR and SII were associated with shorter PFR. Increased values of ELR and eosinophils portend better OS in CC. To our best knowledge, this is the first report describing eosinophils-related biomarker as an independent prognostic factor in CC.