Background: Despite many reported pretreatment prognostic factors in cervical cancer patients, no integrated model has been established. This study aimed to evaluate the prognostic significance of established pretreatment factors in cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT) and to develop a simple and practical model for pretreatment risk stratification. Methods: Fifty-one patients with cervical cancer treated with CCRT between September 2009 and July 2022 were retrospectively analyzed. The median follow-up period was 74.6 months, and the median patient age was 58 years. Clinicopathological and hematological factors, including age, body mass index (BMI), pathology, hemoglobin (Hgb), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), squamous cell carcinoma antigen (SCC-Ag), and International Federation of Gynecology and Obstetrics (FIGO) stage, were collected. Radiological and metabolic factors were assessed using magnetic resonance imaging (MRI), computed tomography (CT), and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), from which the primary tumor volume (pTV) and the maximum standardized uptake value (SUVmax) were measured. The prognostic significance of factors for progression-free survival (PFS) and overall survival (OS) was evaluated using the Cox proportional hazards models. Results: The 5-year OS and PFS rates were 75.5% and 72.6%, respectively. In univariate analyses, BMI (p = 0.020) and FIGO stage (p < 0.001) were associated with PFS, while age, pathology, Hgb, NLR, PLR, SCC-Ag, pTV, and SUVmax were not. Multivariate analysis identified FIGO stage as the only independent prognostic factor for PFS (hazard ratio HR: 4.385; 95% CI: 1.865–10.310; p < 0.001). For OS, Hgb (p = 0.044), BMI (p = 0.024, and FIGO stage (p < 0.001) were significant in univariate analyses, whereas BMI (HR: 3.207; 95% CI: 1.157–8.893; p = 0.025), and FIGO stage (HR: 3.604; 95% CI: 1.559–8.334; p = 0.003) remained significant in the multivariate analysis. The optimal BMI cut-off, determined by the receiver operating characteristic (ROC) analysis, was 21.2 kg/m2. Conclusions: FIGO stage and BMI were the most influential pretreatment factors associated with survival in cervical cancer patients undergoing CCRT. These findings support a straightforward pretreatment risk-stratification approach based on readily obtainable information, intended to assist baseline risk communication rather than guide treatment decisions. External validation in larger, multicenter cohorts is needed to confirm its clinical reliability, but these findings suggest a practical approach to identifying patients with distinct prognostic risks before treatment.
Lee et al. (Thu,) studied this question.