The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy

Emilia Staniewska; Karolina Grudzien; Magdalena Stankiewicz; Katarzyna Raczek-Zwierzycka; Justyna Rembak-Szynkiewicz; Zuzanna Nowicka; Rafal Tarnawski; Marcin Miszczyk

doi:10.3390/cancers16081542

The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy

Cancers (Basel). 2024 Apr 18;16(8):1542. doi: 10.3390/cancers16081542.

Authors

Emilia Staniewska¹, Karolina Grudzien², Magdalena Stankiewicz³, Katarzyna Raczek-Zwierzycka¹, Justyna Rembak-Szynkiewicz⁴, Zuzanna Nowicka⁵, Rafal Tarnawski¹, Marcin Miszczyk^{6

7}

Affiliations

¹ IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland.
² Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland.
³ Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland.
⁴ Radiology and Diagnostic Imaging Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland.
⁵ Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland.
⁶ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
⁷ Collegium Medicum-Faculty of Medicine, WSB University, 41-300 Dąbrowa Górnicza, Poland.

Abstract

Introduction: There is growing interest in the prognostic value of routinely performed pre-treatment blood test indices, such as the RDW or SII, with the latter combining the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). These indices were shown to be prognostic for survival in some malignancies. The purpose of this study was to evaluate the association between pre-treatment RDW and SII, and OS in patients treated with radiotherapy for primary localised cervical cancer.

Material and methods: This retrospective analysis included patients treated with definitive CRT between 2011 and 2017 for histopathologically confirmed FIGO 2018 stage IB2-IVA cervical cancer. Statistical analysis was performed using the Kaplan-Meier method, two-sided log-rank tests, and Cox proportional hazards models, with the AIC serving as a prediction error estimator.

Results: The study group included 249 patients with a median age of 57.2 years and a median follow-up of 75.8 months. The majority were diagnosed with squamous cell carcinoma (237; 95.2%) and had FIGO stage III (211; 84.7%). Approximately half of the patients (116; 46.4%) had regional lymph node metastases. Patients with a low RDW (≤13.4%) and low SII (≤986.01) had a significantly longer OS (p = 0.001 and p = 0.002). The RDW remained as an independent prognostic factor in the multivariable model (high vs. low; HR = 2.04; 95% CI: 1.32-3.16; p = 0.001). Including RDW in the model decreased the Akaike Information Criterion from 1028.25 to 1018.15.

Conclusions: The RDW is a cheap and widely available index that is simultaneously an independent prognostic factor for survival and could be used to improve pre-treatment prognosis assessments in patients with cervical cancer undergoing CRT. Available data encourage assessing the RDW as a prognostic factor in prospective trials to aid the identification of candidates for treatment escalation.

Keywords: cervical cancer; chemoradiation therapy; overall survival; radiotherapy; red cell distribution width; systemic immune-inflammation index.

Grants and funding

This research received no external funding.