AUTHOR=Jiang Yinan , Gu Haifeng , Zheng Xiaojing , Pan Baoyue , Liu Pingping , Zheng Min 

TITLE=Pretreatment C-Reactive Protein/Albumin Ratio is Associated With Poor Survival in Patients With 2018 FIGO Stage IB-IIA HPV-Positive Cervical Cancer

JOURNAL=Pathology and Oncology Research

VOLUME=27

YEAR=2021

URL=https://www.por-journal.com/journals/pathology-and-oncology-research/articles/10.3389/pore.2021.1609946

DOI=10.3389/pore.2021.1609946

ISSN=1532-2807

ABSTRACT=<p><bold>Objectives:</bold> The present study aimed to identify the predictive value of inflammatory indexes stratified according to human papillomavirus (HPV) infection status in women with FIGO 2018 stage IB∼IIA cervical cancer. We also explored the influences of HPV infection status on the survival of cervical cancer patients.</p><p><bold>Methods:</bold> We collected data for 583 women with stage IB∼IIA cervical cancer in Sun Yat-sen University Cancer Center between 2009 and 2017. The <italic>t</italic>-test, chi-squared (χ<sup>2</sup>) test and Fisher’s exact test were applied to compare the differences of inflammatory indexes and clinicopathological features between HPV-positive and HPV-negative groups. Univariate and multivariate analyses were used to identify clinicopathological factors that were associated with the prognosis of cervical cancer patients.</p><p><bold>Results:</bold> There were no differences in overall survival (OS) and progression-free survival (PFS) between HPV-positive and HPV-negative groups. In HPV-positive group, the maximum tumor size, neoadjuvant chemotherapy and the body mass index (BMI) correlated significantly with C-reactive protein/albumin ratio (CAR). The maximum tumor size and the prognostic nutritional index (PNI) correlated significantly with the platelet-lymphocyte ratio (PLR). The maximum tumor size, neoadjuvant chemotherapy and PLR correlated significantly with PNI. Univariate and multivariate analyses showed that the depth of tumor invasion (HR: 3.651, 95% CI: 1.464–9.103, <italic>p</italic> = 0.005; HR: 2.478, 95% CI: 1.218–5.043, <italic>p</italic> = 0.012) and CAR (HR: 5.201, 95% CI: 2.080–13.004, <italic>p</italic> &lt; 0.0001; HR: 2.769, 95% CI: 1.406–5.455, <italic>p</italic> = 0.003) were independent predictors of poor OS and PFS. PNI was an independent protective factor of OS (HR: 0.341, 95% CI: 0.156–0.745, <italic>p</italic> = 0.007). PLR was an independent factor of PFS (HR: 1.991, 95% CI: 1.018–3.894, <italic>p</italic> = 0.044). In HPV-negative group, BMI correlated significantly with CAR. Only depth of invasion (HR: 9.192, 95% CI: 1.016–83.173, <italic>p</italic> = 0.048) was the independent predictor of poor OS, and no inflammation indexes were independent predictors of prognosis.</p><p><bold>Conclusion:</bold> In patients with HPV-positive cervical cancer, depth of invasion, PNI and CAR are independent factors of OS, and depth of invasion, PLR and CAR are independent factors for PFS. For patients with HPV-negative disease, no inflammation indexes had predictive value for prognosis. The predictive value of inflammation indexes on prognosis is more significant in patients with HPV-positive cervical cancer. Stratification of HPV infection status promotes a more precise clinical application of inflammation indexes, thus improving their accuracy and feasibility.</p>