# Role of hematological biomarkers in predicting oncological outcomes of definitive chemoradiation in locally advanced vulvar carcinoma

## TL;DR

This study shows that blood cell ratios like NLR and BLR can predict treatment response and survival in advanced vulvar cancer patients undergoing chemoradiation.

## Contribution

Identifies neutrophil-to-lymphocyte ratio (NLR) and basophil-to-lymphocyte ratio (BLR) as novel predictive biomarkers for treatment outcomes in vulvar carcinoma.

## Key findings

- NLR and BLR were significantly predictive of overall survival in vulvar cancer patients.
- BLR was significantly associated with progression-free survival and treatment response.
- ROC analysis determined optimal cutoffs for NLR (3.4) and BLR (0.035) as predictive thresholds.

## Abstract

The systemic inflammatory response triggered by the carcinogenic process induces significant changes in a wide range of hematological biomarkers, impacting their levels, functions, and overall roles in the body’s physiological and pathological processes.

To evaluate the value of pre-treatment hematological parameters in the prediction of clinical and radiological responses of locally advanced vulvar cancer to definitive chemoradiation.

We retrospectively reviewed the medical records of patients treated at the King Hussein Cancer Center receiving definitive chemoradiation for pathologically confirmed locally advanced vulvar carcinoma. Response of the primary disease to treatment was classified as complete response (CR) if there was no clinically- or radiologically-confirmed residual disease at 12 weeks after completion of chemoradiation. Univariate analyses on complete response, progression-free survival (PFS), and overall survival (OS) were performed using clinical factors and pre-treatment hematological parameters.

A total of 30 patients were included, with a median age of 57.5 years and a median follow-up of 21 months. Of these, 24 patients (80%) achieved CR. Disease progression occurred in 11 patients (36.7%) during the follow-up period, and 9 (30%) died. Kaplan–Meier analysis demonstrated that only the neutrophil–to–lymphocyte ratio (NLR) (p = 0.007) and basophil–to–lymphocyte ratio (BLR) (p = 0.05) were predictive of OS. Conversely, PFS was significantly associated with white blood cell count (p = 0.042) and BLR (p = 0.004). Receiver operating characteristic (ROC) analysis indicated that NLR and BLR had significant predictive power for survival at the following cutoffs: 3.4 and 0.035, respectively. When categorized by ROC values, BLR was significantly associated with response to treatment (p = 0.026). Moreover, both NLR and BLR were significantly associated with OS and PFS.

Pre-treatment NLR and BLR may be useful predictive markers for clinical and radiological response, as well as for oncological outcomes in locally advanced vulvar cancer treated with definitive chemoradiation.