# Systemic inflammation indices and serum squamous cell carcinoma (SCC) antigen: an exploratory analysis on prognosis of patients with vulvar squamous cell carcinoma

## TL;DR

This study explores how blood markers like SCC-Ag and NLR can predict outcomes in vulvar cancer patients, suggesting they could improve risk assessment.

## Contribution

The study introduces a novel combination of SCC-Ag and NLR as a prognostic tool for vulvar squamous cell carcinoma.

## Key findings

- SCC-Ag levels correlate with lymphopenia and higher tumor grade in vulvar cancer patients.
- Combining SCC-Ag and NLR improves postoperative prognosis prediction.
- SCC-Ag elevation indicates a more immunosuppressive systemic profile.

## Abstract

•Elevated SCC-Ag levels correlate with lymphopenia and high tumor grade in VSCC.•The combination of SCC-Ag and NLR improves postoperative prognostic discrimination.•Simple inflammatory indices may enhance risk stratification in vulvar cancer.•SCC-Ag elevation reflects a more immunosuppressive systemic profile.•Integrating hematologic and serum biomarkers could guide tailored surveillance.

Elevated SCC-Ag levels correlate with lymphopenia and high tumor grade in VSCC.

The combination of SCC-Ag and NLR improves postoperative prognostic discrimination.

Simple inflammatory indices may enhance risk stratification in vulvar cancer.

SCC-Ag elevation reflects a more immunosuppressive systemic profile.

Integrating hematologic and serum biomarkers could guide tailored surveillance.

To explore the relationship between hematologic inflammatory indices, serum squamous cell carcinoma antigen (SCC-Ag), and clinicopathological features in vulvar squamous cell carcinoma (VSCC).

Twenty-seven women with primary VSCC were prospectively analyzed. Peripheral leukocyte subsets and derived ratios, including neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and eosinophil-to-lymphocyte ratio (ELR), were assessed preoperatively. SCC-Ag was measured in 16 patients and analyzed using a 1.9  ng/mL cut-off. Associations with tumor grade, recurrence, and mortality were investigated through non-parametric tests and ROC analysis.

Patients with SCC-Ag ≥ 1.9  ng/mL showed significantly lower lymphocyte counts (1.66 vs. 2.41 × 103/µL, p = 0.021) and higher tumor grade (median G3 vs. G2, p = 0.035), along with trends toward higher NLR and lower LMR. No significant differences emerged for other leukocyte subsets or ratios. Exploratory analyses suggested that both SCC-Ag and NLR were associated with recurrence and mortality at 12 months. Their combination improved prognostic discrimination, suggesting a potential role for integrated inflammatory markers in risk stratification.

Elevated SCC-Ag levels in VSCC are associated with lymphopenia and poor tumor differentiation, reflecting an unfavorable systemic immune profile. The combination of SCC-Ag and inflammatory indices, particularly NLR, may offer a simple and cost-effective tool for postoperative prognostic assessment and surveillance planning.