Exponential Slope from Absolute Lymphocyte Counts during Radio-Chemotherapy Can Predict an Aggressive Course of Cervical Cancer

Abstract

This study aimed to investigate whether the exponential slope alpha from absolute lymphocyte counts during concurrent radio-chemotherapy (CRT) is associated with aggressive and non-aggressive courses of cervical cancer. We analyzed 362 patients with stage IB-IVB cervical cancer treated with CRT in two groups: 323 patients without mRNA data (cohort 1) and 39 with mRNA data (cohort 2) from plasma exosomes. We calculated the alpha of each patient; 69 patients who died of cancer in cohort 1 were divided into 44 who died within 30 months (aggressive group), and 25 who died after more than 30 months (non-aggressive group). The median follow-up periods of cohorts 1 and 2 were 63 and 28 months, respectively. The log2 fold change (log2FC) between read counts of mRNAs before treatment and after the second week of CRT was calculated. Multivariate analyses from cohort 1 showed that neutrophil-to-lymphocyte ratio (NLR) >/= 2.43 and alpha < 0.08 were statistically significant predictors of disease-specific survival (DSS) in the aggressive group (DSS-A), whereas alpha >/= 0.08 was the only significant predictor of DSS in the non-aggressive group (DSS-NA). The 2.5-year DSS-A and 8-year DSS-NA rates of patients with alpha >/= 0.08 and alpha < 0.08 were 86.7% and 73%, and 78.5% and 94.8% in the high-NLR group, respectively. In cohort 2, patients with both NLR < 2.7 and alpha >/= 0.07 had a higher 2.5-year DSS rate than did those with either NLR >/= 2.72 or alpha < 0.07. E2F8 and STX6 significantly correlated with a and survival. The 2.5-year DSS rates in patients with E2F8 + STX6 (log2FC) < 0.2429 and >/=0.2429 were 100% and 77.2%, respectively. The exponential slope alpha can potentially distinguish between aggressive and non-aggressive courses in cervical cancer patients.