Combined neutrophil-to-lymphocyte ratio and nomogram for predicting progression-free survival in recurrent/metastatic cervical cancer treated with immune checkpoint inhibitors

Background: The outlook for individuals dealing with metastatic or recurrent cervical cancer is still unfavorable, and existing biomarkers that assess the effectiveness of immune checkpoint inhibitors (ICIs) have certain drawbacks. Our objective was to assess the predictive importance of the combined neutrophil-to-lymphocyte ratio (Combined.NLR), incorporating both pre-treatment and post-treatment measurements in this patient population. Methods: This retrospective cohort analysis, performed at one center, encompassed 148 individuals diagnosed with metastatic or recurrent cervical cancer who underwent treatment with ICIs. Patients were categorized into the Combined.NLR groups according to the median neutrophil-to-lymphocyte ratio (NLR) values obtained before and after treatment. The relationship between the Combined.NLR and progression-free survival (PFS) was examined through Cox regression analysis. A prognostic nomogram that includes various factors was created. Results: The Combined.NLR was identified as an independent prognostic factor for PFS. Individuals classified in the poor group exhibited a notably increased risk of disease progression in comparison to those in the good group [hazard ratio (HR) = 1.355, 95% confidence interval (CI): 1.006-1.824, p = 0.046]. The nomogram, which integrated the Combined.NLR, histological type, PD-L1 expression, the count of previous treatment lines, and the presence of multi-organ metastasis demonstrated a concordance index of 0.70. Calibration curves showed a strong correlation between the predicted results and the actual outcomes. Conclusion: The Combined.NLR is a dynamic and readily accessible prognostic marker. The developed nomogram provides individualized risk prediction for individuals with metastatic or recurrent cervical cancer, potentially aiding clinical decision-making.