{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:58Z","timestamp":1788415978266,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic inflammatory response plays a critical role in tumor progression and immune evasion. Elderly patients with locally advanced cervical squamous cell carcinoma (CSCC) receiving definitive chemoradiotherapy (dCRT) exhibit high prognostic heterogeneity, and there is a lack of simple and effective risk stratification tools. This study aimed to evaluate the prognostic value of pretreatment peripheral blood inflammatory biomarkers and to construct a recursive partitioning analysis (RPA) risk stratification mode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 441 elderly patients with locally advanced CSCC who received dCRT were included. Variable selection was performed using LASSO regression, independent prognostic factors were identified via multivariate Cox regression, and an RPA model was constructed. The performance of the final RPA model was internally validated using bootstrap resampling (1,000 resamples) and 10-fold cross-validation, with the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis (DCA) used as evaluation metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LASSO regression identified seven potential predictive factors from 18 candidate variables. Multivariable Cox regression further confirmed that NLR and SIRI were independent prognostic factors for overall survival and progression-free survival, and SHAP visualization analysis further validated their core contributions. Elevated NLR and SIRI levels were significantly associated with larger tumor diameter, higher FIGO stage, and poorer prognosis. Restricted cubic spline analysis demonstrated a linear association between NLR\/SIRI and OS as well as PFS. A RPA risk stratification model based on NLR, SIRI, and FIGO stage classified patients into low-risk (5-year OS rate: 82.1%), intermediate-risk (70.0%), and high-risk (28.6%) groups. This model showed superior predictive performance compared to traditional FIGO stage and individual inflammatory biomarkers and remained robust across all subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pretreatment NLR and SIRI are independent prognostic biomarkers for survival in elderly patients with locally advanced CSCC undergoing dCRT. The RPA model, which integrates NLR, SIRI and FIGO stage, can be used as an auxiliary prognostic stratification tool, but further external validation is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1935344","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:18:11Z","timestamp":1788412691000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic significance of pretreatment peripheral blood inflammatory biomarkers in elderly patients with locally advanced cervical cancer undergoing definitive chemoradiotherapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiuhua","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjian","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuling","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70043","article-title":"Cancer statistics, 2026","volume":"76","author":"Siegel","year":"2026","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(23)00211-6","article-title":"National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data","volume":"8","author":"Qi","year":"2023","journal-title":"Lancet Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.20892\/j.issn.2095-3941.2025.0386","article-title":"Cervical cancer burden and trends in China, 2000-2020: Asia-Pacific international comparisons and insights for elimination goals","volume":"22","author":"Ma","year":"2025","journal-title":"Cancer Biol Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2025.0057","article-title":"Cervical cancer, version 2.2026, NCCN Clinical Practice Guidelines in Oncology","volume":"23","author":"Abu-Rustum","year":"2025","journal-title":"J Natl Compr Canc Netw"},{"key":"B6","doi-asserted-by":"publisher","first-page":"488","DOI":"10.3390\/cells14070488","article-title":"The role of inflammation in cancer: mechanisms of tumor initiation, progression, and metastasis","volume":"14","author":"Nishida","year":"2025","journal-title":"Cells"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbcan.2025.189502","article-title":"Role of CCL8 in cancer immunity and tumor progression: implications for cancer treatment","volume":"1880","author":"Jeong","year":"2025","journal-title":"Biochim Biophys Acta Rev Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1408700","article-title":"Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review","volume":"15","author":"Tan","year":"2024","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-11868-8","article-title":"Albumin and derived neutrophil-to-lymphocyte ratio is a novel prognostic factor for patients with esophageal squamous cell carcinoma","volume":"29","author":"Abe","year":"2022","journal-title":"Ann Surg Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ijsu.2019.05.018","article-title":"The prognostic nutritional index is prognostic factor of gynecological cancer: a systematic review and meta-analysis","volume":"67","author":"Wang","year":"2019","journal-title":"Int J Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"29500","DOI":"10.1038\/s41598-025-15309-w","article-title":"Combined preoperative platelet-albumin ratio and cancer inflammation prognostic index predicts prognosis in colorectal cancer: a retrospective study","volume":"15","author":"Wang","year":"2025","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.ccr-14-0442","article-title":"Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma","volume":"20","author":"Hu","year":"2014","journal-title":"Clin Cancer Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30057","article-title":"A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy","volume":"122","author":"Qi","year":"2016","journal-title":"Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00011-017-1026-6","article-title":"The diagnostic efficacy of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ovarian cancer","volume":"66","author":"Prodromidou","year":"2017","journal-title":"Inflammation Res"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.06.1061","article-title":"Prognostic value of changes in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) for patients with cervical cancer undergoing definitive chemoradiotherapy (dCRT)","volume":"510","author":"Trinh","year":"2020","journal-title":"Clin Chim Acta"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-019-0222-4","article-title":"Tumour-associated neutrophils in patients with cancer","volume":"16","author":"Shaul","year":"2019","journal-title":"Nat Rev Clin Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s13045-025-01731-0","article-title":"Target neutrophil heterogeneity and plasticity in cancer","volume":"18","author":"Feng","year":"2025","journal-title":"J Hematol Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-022-00737-w","article-title":"Myeloid cell-targeted therapies for solid tumours","volume":"23","author":"Goswami","year":"2023","journal-title":"Nat Rev Immunol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1146\/annurev-pathmechdis-012418-013058","article-title":"Monocytes in the tumor microenvironment","volume":"16","author":"Ugel","year":"2021","journal-title":"Annu Rev Pathol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/s41590-024-01896-9","article-title":"T cell dysfunction and therapeutic intervention in cancer","volume":"25","author":"Zebley","year":"2024","journal-title":"Nat Immunol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1038\/s41423-025-01297-4","article-title":"Adjusting the scope of natural killer cells in cancer therapy","volume":"22","author":"Shen","year":"2025","journal-title":"Cell Mol Immunol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1038\/s41573-024-01098-w","article-title":"Targeting metabolic dysfunction of CD8 T cells and natural killer cells in cancer","volume":"24","author":"Viel","year":"2025","journal-title":"Nat Rev Drug Discov"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-015-0807-6","article-title":"The pretreatment neutrophil-to-lymphocyte ratio predicts therapeutic response to radiation therapy and concurrent chemoradiation therapy in uterine cervical cancer","volume":"20","author":"Mizunuma","year":"2015","journal-title":"Int J Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1461175","article-title":"Evaluating the prognostic relevance of neutrophil-to-lymphocyte ratio in cervical cancer: a systematic review and meta-analysis","volume":"14","author":"Zhuang","year":"2024","journal-title":"Front Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.00766","article-title":"A novel prognostic marker systemic inflammation response index (SIRI) for operable cervical cancer patients","volume":"10","author":"Chao","year":"2020","journal-title":"Front Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1516737","article-title":"The systemic inflammation response index (SIRI) predicts survival in advanced non-small cell lung cancer patients undergoing immunotherapy and the construction of a nomogram model","volume":"15","author":"Tang","year":"2024","journal-title":"Front Immunol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-024-02384-5","article-title":"Predictive effect of the systemic inflammation response index (SIRI) on the efficacy and prognosis of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer","volume":"24","author":"Ding","year":"2024","journal-title":"BMC Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/cas.15964","article-title":"Peripheral blood inflammatory biomarkers dynamics reflect treatment response and predict prognosis in non-small cell lung cancer patients with neoadjuvant immunotherapy","volume":"114","author":"Huai","year":"2023","journal-title":"Cancer Sci"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2025.115122","article-title":"Nomogram for predicting primary resistance to anti-PD-1 therapy in advanced gastric cancer based on dynamic inflammatory markers: a multicenter retrospective study","volume":"162","author":"Qu","year":"2025","journal-title":"Int Immunopharmacol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.3390\/cancers12071896","article-title":"Radiotherapy-induced high neutrophil-to-lymphocyte ratio is a negative prognostic factor in patients with breast cancer","volume":"12","author":"Yoon","year":"2020","journal-title":"Cancers (Basel)"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1935344\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:18:12Z","timestamp":1788412692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1935344\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":30,"alternative-id":["10.3389\/fonc.2026.1935344"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1935344","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1935344"}}