A new score based on biomarker values to predict the prognosis of locally advanced cervical cancer

Abstract

ObjectiveTo define a prognostic score based on pretreatment values of leucocyte, platelet and hemoglobin in locally advanced cervical cancer (LACC). Material and methodsWe conducted a prospective study of 238 patients for LACC with negative PET imaging in the para-aortic (PA) area and who were undergoing laparoscopic PA lymphadenectomies. All patients were treated with chemo-radiation and brachytherapy. ResultsPatients had clinical International Federation of Gynecology and Obstetrics stages IB2 (n = 76), IIA (n = 13), IIB (n = 122), III (n = 18) or IVA (n = 9). We identified three biological parameters (at the time of diagnosis) with three cut-offs which impacted disease free survival (DFS) and overall survival (OS): <12 g/dL for hemoglobin, >10,000/μL for leucocyte and >300 × 109/L for platelet. A score is calculated, as shown in the table below, by adding the scores of all three biological parameters together (with a maximum score of three).Unlabelled TableScore01Hemoglobin≥12 g/dL<12 g/dLLeucocyte≤10,000/μL>10,000/μLPlatelet<300 × 109/L≥300 × 109/LTotal score/3DFS at 36 months was 87.3% [78.3–97.4], 58% [45–74.6], 79.1% [71.1–88], 58% [45–74.6] and 56.8% [37.8–85.4] for scores of 0, 1, 2 and 3 respectively. OS at 36 months was 92.6% [84.9–100], 84% [76.6–92.1], 62.5% [48.9–79.9] and 67% [46.8–96] for scores of 0, 1, 2 and 3 respectively. ConclusionThis score includes three biomarkers with easily remembered cut-offs that allow us to identify, at the time of diagnosis, those patients with a high risk of relapse (scores of two or three) and those requiring dose escalation.