Introduction/Background Radical radiotherapy (RT) is an important treatment modality in the management of locally advanced vulvar cancer. Pre-treatment markers of inflammation, such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), are associated with unfavourable outcomes in various gynaecological malignancies but there is a paucity of data in vulvar cancer. Research to date has focussed on predicting lymph node involvement pre-operatively. Here, we evaluated the impact of NLR/PLR on overall survival in patients undergoing RT for inoperable squamous cell carcinoma of vulva.
Methodology The central radiotherapy prescribing system at the Beatson West of Scotland Cancer Centre was interrogated to identify patients who commenced radical RT (or chemoradiotherapy (CRT)), 1st January 2016 to 31st December 2021, including those who received neoadjuvant chemotherapy (NACT) prior to RT/CRT. NLR and PLR were calculated from neutrophil, lymphocyte, and platelet levels obtained within 28 days of commencing RT/CRT, or NACT. Statistical analysis was performed on Stata®. Cox proportional hazards models were used to estimate unadjusted hazard ratios (HR) for survival.
Results In total, 64 patients were identified; 34 (53%) RT/CRT and 30 (47%) had NACT followed by RT/CRT. Patient demographics, tumour characteristics, and treatment details are illustrated in table 1. Median follow up was 23.5 months (range 2–93 months). By the study end (31st December 2022), 35 (55%) patients had relapsed and 33 (51%) had died. Univariate analysis revealed that age >70 years, median EQD2, use of concomitant cisplatin (but not NACT), and NLR/PLR were associated with survival. Multivariate analysis demonstrated that NLR (HR 2.09, CI 1.23–3.53, p<0.05) and PLR (HR 1.62, CI 1.06–2.48, p<0.05) were significantly associated with survival.
Conclusion NLR and PLR correlate with poorer overall survival in patients receiving radical RT/CRT for vulvar cancer.
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