A Novel Prognostic Marker Systemic Inflammation Response Index (SIRI) for Operable Cervical Cancer Patients

Abstract

It has been confirmed that the systemic inflammation response index (SIRI) based on peripheral blood neutrophil, monocyte and lymphocyte counts can be used for the prognostication of patients with various malignant tumors. However, the prognostic value of SIRI in cervical cancer patients has not yet been reported. This study found that a higher SIRI was related to lymphovascular invasion and was also significantly associated with FIGO stage, radiotherapy, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) but not related to other clinical and pathological parameters. According to the Kaplan-Meier survival analysis, a high SIRI was associated with the poor prognosis of cervical cancer patients in the primary and validation groups. SIRI, NLR, PLR, and MLR can all be used to determine the prognosis of patients with operable cervical cancer. Moreover, it was confirmed that only SIRI was an independent prognostic factor for patients with operable cervical cancer. The same result was obtained in the propensity score matching (PSM) analysis. In the ROC curve analysis, SIRI was more accurate in predicting the prognosis of cervical cancer patients. Then, a nomogram was established based on SIRI, FIGO stage and lymphovascular invasion, which could determine the prognosis of cervical cancer patients more accurately than FIGO stage. The validation cohort showed the same results. In addition, the changes in SIRI relative to the baseline value at 4-8 weeks after surgery were closely related to the survival of cervical cancer patients. Compared with those with unchanged SIRI (absolute value of variation <25%), cervical cancer patients with an increase in SIRI > 75% had worse OS (P < 0.001), while patients with a decrease in SIRI > 75% had a better prognosis (P < 0.001). SIRI can serve as a new independent prognostic index and a potential marker for therapeutic response monitoring in patients with curable cervical cancer. Compared with the traditional FIGO staging system, the nomogram integrating SIRI can predict the survival of cervical cancer patients more objectively and reliably after radical surgery.

Keywords: PSM; cervical cancer; nomogram; prognosis; systemic inflammation response index.

Figure 1

Kaplan–Meier curves for patients stratified based on (A) SIRI, (B) NLR, (C) PLR and (D) MLR in operable cervical cancer patients. Predictive ability of the SIRI in operable cervical cancer patients was compared with NLR, PLR, and MLR by ROC curves in 3-years (E) and 5-years (F).

Figure 2

Kaplan–Meier survival curves for patients stratified based on SIRI after propensity matching.

Figure 3

The nomogram integrating SIRI, lymphovascular invasion and FIGO in operable cervical cancer.

Figure 4

(A) The 3-years survival rate of cervical cancer patients predicted by nomogram is highly consistent with the actual observed values. (B) The 5-years survival rate of cervical cancer patients predicted by nomogram is highly consistent with the actual observed values. (C) The ability of ROC analysis nomogram to predict the 3-years survival rate of the cervical cancer patients, the nomogram has a larger AUC than FIGO staging. (D) The ability of ROC analysis nomogram to predict the 5-years survival rate of the cervical cancer patients, the nomogram has a larger AUC than FIGO staging.

Figure 5

(A) Kaplan–Meier survival curves for patients stratified based on SIRI in validation cohort. (B) The 3-years survival rate of cervical cancer patients predicted by nomogram is highly consistent with the actual observed values in validation cohort. (C) The 5-years survival rate of cervical cancer patients predicted by nomogram is highly consistent with the actual observed values in validation cohort. (D) The ability of ROC analysis nomogram to predict the 3-years survival rate of the cervical cancer patients, the nomogram has a larger AUC than FIGO staging in validation cohort. (E) The ability of ROC analysis nomogram to predict the 5-years survival rate of the cervical cancer patients, the nomogram has a larger AUC than FIGO staging in validation cohort.

Figure 6

(A) Different changes of SIRI before and after radical operation in cervical cancer have significant prognostic value. (B) Compared with those with unchanged SIRI (absolute value of variation <25%), cervical cancer patients with an increase in SIRI > 75% had worse OS (P < 0.001), while patients with a decrease in SIRI > 75% had a better prognosis (P < 0.001).