CN95 - A novel nomogram based on inflammation biomarkers for predicting radiation cystitis in patients with local advanced cervical cancer

Background

Radiation cystitis (RC) is a common side-effect of pelvic radiation, which could severely impair patients' quality of life. Platelet-to-albumin ratio (PAR) is a new systemic inflammatory indicator associated with many inflammatory diseases. This study aimed to explore whether PAR could be used as an effective parameter for predicting the RC for local advanced cervical cancer (LACC) treated with radiotherapy.

Methods

319 LACC patients at Fujian Cancer Hospital were enrolled between December 2018 and January 2021. All patients received radiotherapy with or without chemotherapy. Clinical parameters were retrospectively analyzed. Logistic analyses were used to identify the risk factors for RC. Risk factors in univariate analysis (p<0.05) were put in a backward and stepwise regression to construct two nomograms-one with primary significant factors and the other with extra inflammatory biomarkers. A DeLong test was applied to compare the prediction abilities of two nomograms. The stability and credibility of the nomogram with inflammatory biomarkers were assessed by five-fold validation, calibration curves, and decision curve analysis (DCA).

Results

Univariate analysis showed age, tumor size, stage, total radiation dose, pelvic radiation dose, systemic immune-inflammation index(SII), platelet-to-lymphocyte ratio (PLR), and PAR were significantly associated with RC (all p < 0.05). Multivariate analyses indicated age, tumor size, stage, total radiation dose, and PAR were independent factors (all p < 0.05). Then, the area under curve (AUC) value of the nomogram_SII+PAR was 0.774 compared to that of the baseline nomogram (AUC = 0.726) (P _Delong = 0.02), indicating the great discriminative power of the nomogram_SII+PAR and enhancing the critical roles of SII and PAR in predicting RC. Also, the five-cross validation validated the stability of the nomogram_SII+PAR. Moreover, the calibration curve and DCA exhibited the nomograms' good prediction consistency and clinical practicability.

Conclusions

PAR and SII could be valued for cervical cancer patients with radiation therapy to stratify patients who require extra intervention to prevent bladder radiation damage and improve patients' quality of life.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Major Scientific Research Program for Young and Middle-aged Health Professionals of Fujian, Province, China(Grant NO. 2022ZQNZD008).

Disclosure

All authors have declared no conflicts of interest.