The value of tertiary lymphoid structure on predicting the survival rate of advanced cervical cancer patients

Cervical cancer (CC) ranks as the fourth most prevalent cancer among women worldwide. However, for patients with advanced-stage disease, reliable prognostic markers remain scarce. In this study, we evaluated the combined prognostic value of tertiary lymphoid structures (TLS) and systemic hematological parameters in CC. In this retrospective study, we enrolled 232 cervical cancer patients diagnosed with stage IIb-IV disease. Formalin-fixed, paraffin-embedded tissue sections were analyzed using hematoxylin-eosin (HE) staining and immunohistochemistry to quantify tertiary lymphoid structure (TLS) density. Peripheral blood samples were obtained to assess hematological parameters. The prognostic significance of these factors for overall survival (OS) was evaluated through Kaplan-Meier survival analysis and both univariate and multivariate Cox proportional hazards regression models. Our study found that high TLS expression correlated significantly with improved prognosis(HR = 0.48, 95% CI: 0.29–0.79, p = 0.004), However, LS alone demonstrated limited predictive accuracy as an independent prognostic marker (AUC = 0.559, 95% CI: 0.490–0.628). Therefore, we integrated systemic hematological parameters and identified that the combination of TLS and D-Dimer was a stronger predictor of patient survival than other factors (AUC = 0.687, 95% CI: 0.609–0.764, p < 0.001). Through multivariate Cox regression analysis, we subsequently developed a prognostic nomogram incorporating TLS, AST/ALT ratio, CEA, CA199, and D-dimer levels, providing clinicians with a novel, comprehensive tool for patient outcome assessment. The combination of TLS density and D-Dimer levels provides enhanced prognostic evaluation for patients with advanced cervical cancer. This approach may offer a new intervention pathway for those with poor prognosis.