Prognostic Value of Body Composition and Systemic Inflammatory Markers in Patients with Locally Advanced Cervical Cancer Following Chemoradiotherapy

Figures & data

Table 1 Basic Clinicopathologic Characteristics of Cervical Cancer

Characteristics	Variables	N (%)
Clinicopathologic
Age	< 60	147 (75)
	≥ 60	49 (25)
Stage (Figo 2018)	IIB	35 (17.9)
	IIIB	83 (42.3)
	IIIC1r	78 (39.8)
Histological type	Adenocarcinoma	10 (5.1%)
	Squamous cell carcinoma	186 (94.9)
Tumor size	< 4 cm	37 (18.9)
	≥ 4 cm	159 (81.1)
Tumor grade	G1	31 (15.8)
	G2	71 (36.2)
	G3	94 (48.0)
Systemic inflammation
LMR	< 4.04	104 (53.1)
	≥ 4.04	92 (46.9)
NLR	< 2.38	76 (38.8)
	≥ 2.38	120 (61.2)
NPR	< 0.014	75 (38.3)
	≥ 0.014	121 (61.7)
PLR	< 178.61	109 (55.6)
	≥ 178.61	87 (44.4)
RDW	< 10.83	66 (33.7)
	≥ 10.83	130 (66.3)
PNI	< 54.34	139 (70.9)
	≥ 54.34	57 (29.1)
SII	< 1377.37	167 (85.2)
	≥ 1377.37	29 (14.8)
Body composition
BMI (kg/m^2)	< 25	99 (50.5)
	≥ 25	97 (49.5)
SMI (cm^2 /m^2)	< 41	89 (45.4)
	≥ 41	107 (54.6)
SAI (cm^2 /m^2)	< 91.77	166 (84.7)
	≥ 91.77	30 (15.3)
VAI (cm^2 /m^2)	< 34.89	94 (48.0)
	≥ 34.89	102 (52.0)
IMAI (cm^2 /m^2)	< 5.85	164 (83.7)
	≥ 5.85	32 (16.3)

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index; SMI, skeletal muscle index; SAI, subcutaneous adipose index; VAI, visceral adipose index; IMAI, intra-muscular adipose index.

Table 2 Univariate and Multivariate Logistic Analysis Among Clinicopathologic Parameters, Systemic Inflammatory Markers, and Sarcopenia

Variables	Sarcopenia
	Univariable			Multivariable
	OR	95% CI	P-value	OR	95% CI	P-value
Age (≥ 60 vs < 60)	1.88	0.98–3.65	0.059	3.49	1.63–7.8	0.002
Stage
IIB	Ref
IIIB	0.89	0.4–1.98	0.782
IIIC1r	0.82	0.37–1.83	0.623
Histological type
Adenocarcinoma	Ref
Squamous cell carcinoma	0.82	0.22–3.05	0.765
Tumor size (≥ 4 cm vs < 4 cm)	1.69	0.81–3.64	0.166	2.46	1.08–5.95	0.038
Tumor grade
G1	Ref
G2	1.27	0.55–3.03	0.579
G3	1.12	0.49–2.58	0.789
BMI (≥ 25 vs < 25)	0.36	0.2–0.64	0.001	0.29	0.15–0.54	<0.001
LMR (≥ 4.04 vs < 4.04)	0.67	0.38–1.18	0.171
NLR (≥ 2.38 vs < 2.38)	1.14	0.64–2.04	0.657
NPR (≥ 0.014 vs < 0.014)	0.84	0.47–1.51	0.566
PLR (≥ 178.61 vs < 178.61)	1.46	0.83–2.57	0.195	1.97	1.04–3.79	0.039
RDW (≥ 10.83 vs < 10.83)	1	0.55–1.81	0.993
PNI (≥ 54.34 vs < 54.34)	0.75	0.4–1.39	0.363
SII (≥ 1377.37 vs < 1377.37)	1.35	0.61–2.99	0.46

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index.

Table 3 Univariate and Multivariate Logistic Analysis Among Clinicopathologic Parameters, Systemic Inflammatory Markers, and SAI

Variables	SAI
	Univariable			Multivariable
	OR	95% CI	P-value	OR	95% CI	P-value
Age (≥ 60 vs < 60)	0.72	0.25–1.77	0.493	0.38	0.11–1.15	0.105
Stage
IIB	Ref
IIIB	2	0.67–7.38	0.247
IIIC1r	1.01	0.3–3.96	0.986
Histological type
Adenocarcinoma	Ref
Squamous cell carcinoma	0.71	0.17–4.86	0.674
Tumor size (≥ 4 cm vs < 4 cm)	0.58	0.24–1.51	0.24	0.27	0.08–0.87	0.028
Tumor grade
G1	Ref
G2	3.25	0.82–21.67	0.137	5.97	1.09–53.02	0.064
G3	2.75	0.72–18.15	0.196	3.63	0.71–29.91	0.163
BMI (≥ 25 vs < 25)	8.7	3.21–30.47	<0.001	11.16	3.91–40.85	<0.001
LMR (≥ 4.04 vs < 4.04)	0.72	0.32–1.57	0.409	0.51	0.2–1.26	0.149
NLR (≥ 2.38 vs < 2.38)	0.8	0.37–1.79	0.578
NPR (≥ 0.014 vs < 0.014)	0.66	0.3–1.47	0.306	0.35	0.13–0.91	0.034
PLR (≥ 178.61 vs < 178.61)	0.81	0.36–1.77	0.6	0.46	0.16–1.27	0.139
RDW (≥ 10.83 vs < 10.83)	1.48	0.64–3.72	0.38
PNI (≥ 54.34 vs < 54.34)	0.87	0.34–2.02	0.752
SII (≥ 1377.37 vs < 1377.37)	0.87	0.24–2.47	0.806

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index; SMI, skeletal muscle index; SAI, subcutaneous adipose index.

Table 4 Univariate and Multivariate Logistic Analysis Among Clinicopathologic Parameters, Systemic Inflammatory Markers, and VAI

Variables	VAI
	Univariable			Multivariable
	OR	95% CI	P-value	OR	95% CI	P-value
Age (≥ 60 vs < 60)	2.63	1.34–5.36	0.006
Stage
IIB	Ref
IIIB	1.43	0.64–3.18	0.377
IIIC1r	0.73	0.33–1.63	0.44
Histological type
Adenocarcinoma	Ref			Ref
Squamous cell carcinoma	0.26	0.04–1.05	0.09	0.23	0.03–1.12	0.094
Tumor size (≥ 4 cm vs < 4 cm)	0.52	0.24–1.08	0.086	0.42	0.17–0.98	0.05
Tumor grade
G1	Ref
G2	0.7	0.3–1.64	0.416
G3	0.79	0.34–1.78	0.566
BMI (≥ 25 vs < 25)	5.99	3.27–11.28	<0.001	7.98	4.07–16.47	<0.001
LMR (≥ 4.04 vs < 4.04)	1.66	0.94–2.93	0.08
NLR (≥ 2.38 vs < 2.38)	0.48	0.26–0.86	0.014
NPR (≥ 0.014 vs < 0.014)	0.77	0.43–1.38	0.383	0.43	0.21–0.86	0.019
PLR (≥ 178.61 vs < 178.61)	0.46	0.26–0.81	0.008	0.3	0.14–0.6	0.001
RDW (≥ 10.83 vs < 10.83)	1.03	0.57–1.87	0.916
PNI (≥ 54.34 vs < 54.34)	1.54	0.83–2.91	0.173
SII (≥ 1377.37 vs < 1377.37)	0.51	0.22–1.13	0.103

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index; SMI, skeletal muscle index; VAI, visceral adipose index.

Table 5 Univariate and Multivariate Logistic Analysis Among Clinicopathologic Parameters, Systemic Inflammatory Markers, and IMAI

Variables	IMAI
	Univariable			Multivariable
	OR	95% CI	P-value	OR	95% CI	P-value
Age (≥ 60 vs < 60)	4.27	1.92–9.61	<0.001	3.28	1.28–8.65	0.014
Stage
IIB	Ref
IIIB	0.92	0.3–3.11	0.881	0.97	0.26–4.07	0.968
IIIC1r	1.43	0.5–4.72	0.526	3.04	0.79–13.87	0.125
Histological type
Adenocarcinoma	Ref
Squamous cell carcinoma	0.74	0.17–5.06	0.711
Tumor size (≥ 4 cm vs < 4 cm)	0.61	0.26–1.58	0.286
Tumor grade
G1	Ref
G2	0.47	0.18–1.25	0.125	0.43	0.13–1.37	0.153
G3	0.2	0.07–0.55	0.002	0.17	0.05–0.59	0.006
BMI (≥ 25 vs < 25)	2.93	1.31–7.07	0.011	3.9	1.57–10.65	0.005
LMR (≥ 4.04 vs < 4.04)	1.07	0.49–2.32	0.86
NLR (≥ 2.38 vs < 2.38)	0.39	0.18–0.85	0.019	0.3	0.11–0.8	0.019
NPR (≥ 0.014 vs < 0.014)	0.98	0.45–2.2	0.956
PLR (≥ 178.61 vs < 178.61)	0.54	0.23–1.2	0.142
RDW (≥ 10.83 vs < 10.83)	0.66	0.3–1.46	0.291
PNI (≥ 54.34 vs < 54.34)	0.54	0.19–1.31	0.199	0.32	0.1–0.95	0.051
SII (≥ 1377.37 vs < 1377.37)	0.35	0.05–1.27	0.17

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index; SMI, skeletal muscle index; IMAI, intra- muscularadipose index.

Table 6 Univariable and Multivariable Cox Analyses Associated with Overall Survival

Variables	Univariable			Multivariable
	HR	95% CI	P-value	HR	95% CI	P-value
Age (≥ 60 vs < 60)	2.12	0.92–4.9	0.08
Stage
IIB	Ref
IIIB	4.64	0.6–35.94	0.142	6.03	0.7–51.85	0.102
IIIC1r	5.02	0.65–38.86	0.123	9.69	1.05–89.22	0.045
Histological type
Adenocarcinoma	Ref
Squamous cell carcinoma	1.19	0.16–8.85	0.863
Tumor size (< 4 cm vs ≥ 4 cm)	0.48	0.2–1.13	0.094
Tumor grade
G1	Ref
G2	1.15	0.3–4.43	0.844
G3	1.45	0.41–5.08	0.563
LMR (≥ 4.04 vs < 4.04)	2.4	1.02–5.68	0.046	4.35	0.99–19.13	0.052
NLR (≥ 2.38 vs < 2.38)	0.42	0.18–0.95	0.038	0.29	0.07–1.24	0.095
NPR (≥ 0.014 vs < 0.014)	1.67	0.66–4.23	0.282	3.23	1.12–9.26	0.03
PLR (≥ 178.61 vs < 178.61)	0.53	0.22–1.28	0.158
RDW (≥ 10.83 vs < 10.83)	0.54	0.24–1.23	0.144	0.5	0.21–1.21	0.125
PNI (≥ 54.34 vs < 54.34)	0.66	0.25–1.79	0.417	0.24	0.07–0.8	0.02
SII (≥ 1377.37 vs < 1377.37)	2.34	0.92–5.93	0.075	7.35	1.88–28.66	0.004
BMI (≥ 25 vs < 25)	0.99	0.43–2.23	0.972	0.23	0.07–0.77	0.017
Sarcopenia (Yes vs No)	2.08	0.88–4.9	0.095	3.6	1.4–9.23	0.008
SAI (≥ 91.77 vs < 91.77)	1.82	0.67–4.9	0.237	4.7	1.33–16.66	0.016
VAI (≥ 34.89 vs < 34.89)	2.33	0.96–5.67	0.062	7.53	2.27–25.01	0.001
IMAI (≥ 5.85 vs < 5.85)	2.1	0.83–5.34	0.117

Abbreviations: NLR, neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NPR, neutrophil-to-platelet ratio; PLR, platelet-to-lymphocyte ratio; RDW, red blood cell distribution width; PNI, prognostic nutritional index; SII, index of systemic immune-inflammation; BMI, body mass index; SMI,

skeletal muscle index; SAI, subcutaneous adipose index; VAI, visceral adipose index; IMAI, intra-muscular adipose index.

Figure 1 Kaplan-Meier plot of association between body composition combined with inflammation markers and OS. (A) LMR + Sarcopenia. (B) NLR + Sarcopenia. (C) SII + VAI. (D) SII + IMAI. (E) LMR + SAI.

Abbreviations: OS, overall survive; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SAI, skeletal muscle index; VAI, visceral adipose index; SII, systemic immune-inflammation index; IMAI, intra-muscular adipose index.

Figure 2 Nomogram for predicting survival. (A) Nomogram to predict the 3-year and 5-year overall survival rates of LACC patients. Calibration plot of the nomogram for the (B) 3-year and (C) 5-year survival rates.