Young Sub Lee

Tumour budding in pretreatment cervical biopsies: a prognosticator for personalised therapy in the era of precision oncology

Aims Tumour budding (TB) is a noteworthy morphologic indicator for tumour microenvironment (TME) especially because it is detectable with routine haematoxylin and eosin (H&E) staining. Its prognostic relevance has been demonstrated across various cancers, but its significance in pretreatment biopsy specimens of cervical cancer is unknown. This is the first study to investigate the prognostic value of TB in pretreatment cervical biopsy. Additional TME features identifiable with H&E such as cell nest size (CNS) were evaluated. Methods and results A retrospective review was conducted on the 2018 International Federation of Gynaecology and Obstetrics (FIGO) stage IIVA cervical cancer patients ( N  = 182) who had completed standard treatment. In multivariate analysis, TB (hazard ratio [HR], 2.06) and CNS (HR, 2.16) independently predicted overall survival. While TB (AUC, 0.7065) slightly outperformed CNS (AUC, 0.6975) in discriminating overall survival, the combination of TB and CNS demonstrated the highest performance (AUC, 0.7192) in time‐dependent receiver operating characteristic analysis. Conclusions This study is the first to suggest TB in pretreatment biopsy specimens as a reliable morphologic prognosticator in cervical cancer. TME features may enhance precision oncology by offering insights into the individual tumour biology. The fact that these morphologic features are available from routine H&E slides, reserving immunohistochemistry or molecular analysis for indeterminate cases, is of particular value in low‐resource settings where the burden of cervical cancer is most significant.

Dynamics of Serum Inflammatory Markers Predict Survival After Definitive Chemoradiotherapy for Locally Advanced Cervical Cancer

ABSTRACT Aim Cervical cancer is caused by persistent infection with the human papillomavirus. This study aimed to investigate whether the changes in serum inflammatory markers between baseline and posttreatment can predict survival in cervical cancer undergoing definitive chemoradiotherapy (CCRT). Methods Eighty‐one Stage IB–IVA cervical cancer patients treated with definitive CCRT, with serum inflammatory markers obtained at diagnosis and after completion of pre‐planned therapy, were included. The percent changes of post‐/pretreatment levels × 100% were calculated for neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), monocyte‐to‐lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and systemic immune‐inflammation index (SII). The cutoffs were obtained with the maximal chi‐square statistics. Results At a median follow‐up of 28 months, the 2‐year overall survival (OS) was 75.4%. The 2‐year OS for patients with low versus high percent change was as follows: post‐/pre‐NLR (87.7% vs. 67.8%), post‐/pre‐MLR (75.9% vs. 71.1%), post‐/pre‐SIRI (76.5% vs. 61.7%), and post‐/pre‐SII (91.7% vs. 67.2%) (all p < 0.05). The hazard ratios (HR) in multivariate analysis were as follows: post‐/pre‐NLR (5.53, 95% confidence interval [CI]: 1.65–18.52), post‐/pre‐MLR (3.39, 95% CI: 1.39–8.26), post‐/pre‐SIRI (5.11, 95% CI: 1.92–13.57), and post‐/pre‐SII (6.57, 95% CI: 1.77–24.36) (all p < 0.05). Conclusion This study demonstrates the impact of the dynamics of serum inflammatory markers on survival. It has been consistently demonstrated across the markers. To adopt these markers for personalized treatment decisions, a better understanding of their relation with the actual tumor microenvironment is warranted.