A retrospective analysis of the prognostic value of nutritional-inflammatory markers for patients with cervical cancer.
Elevated inflammatory markers are consistently linked to poor outcomes in cancer, whereas favorable nutritional status correlates with improved survival. This retrospective study examined the interaction between nutritional-inflammatory indices and their impact on outcomes in patients with cervical cancer.
Data from 465 cervical cancer patients treated at the Second Affiliated Hospital of Soochow University between January 2015 and June 2025 were retrospectively analyzed. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), Prognostic Nutritional Index (PNI), and Naples Prognostic Score (NPS) were calculated. Associations of these indices with overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method and Cox regression models. Prognostic value was further evaluated through construction of a nomogram, with predictive accuracy validated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration analysis.
Significant differences between deceased patients and survivors were observed in body mass index (BMI), tumor burden, tumor markers, nutritional/inflammatory indices, pathological characteristics, and treatment status (all p < 0.05). Higher LMR, lower NLR, elevated PNI, and lower NPS were associated with improved OS and PFS (p < 0.001). Multivariate analysis identified BMI, PNI, Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage, differentiation, CA125, HPV infection, and targeted therapy as independent determinants of OS, while BMI, tumor volume, PNI, HPV infection, histology, differentiation, FIGO stage, and NPS independently predicted PFS. BMI exhibited a linear relationship with both OS and PFS, while PNI demonstrated a linear negative correlation with OS and a significant non-linear relationship with PFS. Nomograms incorporating eight variables for OS and six for PFS achieved AUC values ≥ 0.86 at 3-, 5-, and 10-year timepoints, demonstrating reliable discrimination, accurate calibration, and greater net clinical benefit compared with individual markers. Subgroup analyses consistently indicated protective effects of PNI (HR∼0.9) and low NPS (HR 0.3-0.9), though prognostic strength varied slightly according to clinical context and treatment approach.
PNI was validated as a robust independent prognostic factor for both OS and PFS, while NPS demonstrated independent predictive value specifically for PFS. As easily obtainable nutritional-inflammatory indices, they complement conventional clinicopathological parameters. The integrated prognostic model established in this study shows exploratory potential in estimating OS and PFS. Pending future external validation, it may serve as an adjunctive reference for risk stratification and follow-up optimization.
Data from 465 cervical cancer patients treated at the Second Affiliated Hospital of Soochow University between January 2015 and June 2025 were retrospectively analyzed. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), Prognostic Nutritional Index (PNI), and Naples Prognostic Score (NPS) were calculated. Associations of these indices with overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method and Cox regression models. Prognostic value was further evaluated through construction of a nomogram, with predictive accuracy validated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration analysis.
Significant differences between deceased patients and survivors were observed in body mass index (BMI), tumor burden, tumor markers, nutritional/inflammatory indices, pathological characteristics, and treatment status (all p < 0.05). Higher LMR, lower NLR, elevated PNI, and lower NPS were associated with improved OS and PFS (p < 0.001). Multivariate analysis identified BMI, PNI, Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage, differentiation, CA125, HPV infection, and targeted therapy as independent determinants of OS, while BMI, tumor volume, PNI, HPV infection, histology, differentiation, FIGO stage, and NPS independently predicted PFS. BMI exhibited a linear relationship with both OS and PFS, while PNI demonstrated a linear negative correlation with OS and a significant non-linear relationship with PFS. Nomograms incorporating eight variables for OS and six for PFS achieved AUC values ≥ 0.86 at 3-, 5-, and 10-year timepoints, demonstrating reliable discrimination, accurate calibration, and greater net clinical benefit compared with individual markers. Subgroup analyses consistently indicated protective effects of PNI (HR∼0.9) and low NPS (HR 0.3-0.9), though prognostic strength varied slightly according to clinical context and treatment approach.
PNI was validated as a robust independent prognostic factor for both OS and PFS, while NPS demonstrated independent predictive value specifically for PFS. As easily obtainable nutritional-inflammatory indices, they complement conventional clinicopathological parameters. The integrated prognostic model established in this study shows exploratory potential in estimating OS and PFS. Pending future external validation, it may serve as an adjunctive reference for risk stratification and follow-up optimization.