Chemotherapy-related leukopenia as a biomarker predicting survival outcomes in locally advanced cervical cancer

Giorgio Bogani, Ilaria Sabatucci, Giuseppa Maltese, Francesca Lecce, Mauro Signorelli, Fabio Martinelli, Valentina Chiappa, Alice Indini, Umberto Leone Roberti Maggiore, Chiara Borghi, Giovanni Fucà, Antonino Ditto, Francesco Raspagliesi, Domenica Lorusso

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective To investigate the impact of hematologic toxicity and leukopenia in locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy (NACT). Study design Data of consecutive patients undergoing platinum-based NACT followed by surgery were retrospectively searched in order to evaluate the impact of chemotherapy-related toxicity on survival outcomes. Toxicity was graded per the Common Terminology Criteria for Adverse Events (CTCAEv.4.03). Survival outcomes were evaluated using Kaplan-Meir and Cox hazard models. Results Overall, 126 patients were included. Among those, 94 (74.6%) patients experienced grade2+ hematologic toxicity; while, grade2+ non-hematologic toxicity occurred in 11 (8.7%) patients. After a median follow-up of 37.1 (inter-quartile range, 12–57.5) months, 21 (16.6%) patients experienced recurrence. Via multivariate analysis, no factor was independently associated with disease-free survival; while a trend toward worse prognosis was observed for patients experiencing grade2+ leukopenia at cycle-3 (HR:3.13 (95%CI: 0.94, 10.3); p = 0.06). Similarly, grade2+ leukopenia (HR:9.98 (95%CI: 1.14, 86.6); p = 0.03), lymph-node positivity (HR:14.6 (95%CI:1.0, 214.4); p = 0.05) and vaginal involvement (HR:5.81 (95%CI:1.43, 23.6); p = 0.01) impacted on overall survival, at multivariate analysis. Magnitude of leukopenia correlated with survival (p<0.001). Conclusions Although, our data have to be confirmed by prospective investigations, the present study shows an association between the occurrence of leukopenia and survival outcomes. NACT-related immunosuppression might reduce the response against the tumor, thus promoting cancer progression.

Original languageEnglish
Pages (from-to)41-45
Number of pages5
JournalEuropean Journal of Obstetrics, Gynecology and Reproductive Biology
Volume208
DOIs
Publication statusPublished - Jan 1 2017

Fingerprint

Leukopenia
Uterine Cervical Neoplasms
Biomarkers
Drug Therapy
Survival
Proportional Hazards Models
Multivariate Analysis
Platinum
Terminology
Immunosuppression
Disease-Free Survival
Neoplasms
Lymph Nodes
Recurrence

Keywords

  • Cervical cancer
  • Leukopenia
  • Neoadjuvant chemotherapy
  • Survival

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Chemotherapy-related leukopenia as a biomarker predicting survival outcomes in locally advanced cervical cancer. / Bogani, Giorgio; Sabatucci, Ilaria; Maltese, Giuseppa; Lecce, Francesca; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Indini, Alice; Leone Roberti Maggiore, Umberto; Borghi, Chiara; Fucà, Giovanni; Ditto, Antonino; Raspagliesi, Francesco; Lorusso, Domenica.

In: European Journal of Obstetrics, Gynecology and Reproductive Biology, Vol. 208, 01.01.2017, p. 41-45.

Research output: Contribution to journalArticle

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abstract = "Objective To investigate the impact of hematologic toxicity and leukopenia in locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy (NACT). Study design Data of consecutive patients undergoing platinum-based NACT followed by surgery were retrospectively searched in order to evaluate the impact of chemotherapy-related toxicity on survival outcomes. Toxicity was graded per the Common Terminology Criteria for Adverse Events (CTCAEv.4.03). Survival outcomes were evaluated using Kaplan-Meir and Cox hazard models. Results Overall, 126 patients were included. Among those, 94 (74.6{\%}) patients experienced grade2+ hematologic toxicity; while, grade2+ non-hematologic toxicity occurred in 11 (8.7{\%}) patients. After a median follow-up of 37.1 (inter-quartile range, 12–57.5) months, 21 (16.6{\%}) patients experienced recurrence. Via multivariate analysis, no factor was independently associated with disease-free survival; while a trend toward worse prognosis was observed for patients experiencing grade2+ leukopenia at cycle-3 (HR:3.13 (95{\%}CI: 0.94, 10.3); p = 0.06). Similarly, grade2+ leukopenia (HR:9.98 (95{\%}CI: 1.14, 86.6); p = 0.03), lymph-node positivity (HR:14.6 (95{\%}CI:1.0, 214.4); p = 0.05) and vaginal involvement (HR:5.81 (95{\%}CI:1.43, 23.6); p = 0.01) impacted on overall survival, at multivariate analysis. Magnitude of leukopenia correlated with survival (p<0.001). Conclusions Although, our data have to be confirmed by prospective investigations, the present study shows an association between the occurrence of leukopenia and survival outcomes. NACT-related immunosuppression might reduce the response against the tumor, thus promoting cancer progression.",
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T1 - Chemotherapy-related leukopenia as a biomarker predicting survival outcomes in locally advanced cervical cancer

AU - Bogani, Giorgio

AU - Sabatucci, Ilaria

AU - Maltese, Giuseppa

AU - Lecce, Francesca

AU - Signorelli, Mauro

AU - Martinelli, Fabio

AU - Chiappa, Valentina

AU - Indini, Alice

AU - Leone Roberti Maggiore, Umberto

AU - Borghi, Chiara

AU - Fucà, Giovanni

AU - Ditto, Antonino

AU - Raspagliesi, Francesco

AU - Lorusso, Domenica

PY - 2017/1/1

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N2 - Objective To investigate the impact of hematologic toxicity and leukopenia in locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy (NACT). Study design Data of consecutive patients undergoing platinum-based NACT followed by surgery were retrospectively searched in order to evaluate the impact of chemotherapy-related toxicity on survival outcomes. Toxicity was graded per the Common Terminology Criteria for Adverse Events (CTCAEv.4.03). Survival outcomes were evaluated using Kaplan-Meir and Cox hazard models. Results Overall, 126 patients were included. Among those, 94 (74.6%) patients experienced grade2+ hematologic toxicity; while, grade2+ non-hematologic toxicity occurred in 11 (8.7%) patients. After a median follow-up of 37.1 (inter-quartile range, 12–57.5) months, 21 (16.6%) patients experienced recurrence. Via multivariate analysis, no factor was independently associated with disease-free survival; while a trend toward worse prognosis was observed for patients experiencing grade2+ leukopenia at cycle-3 (HR:3.13 (95%CI: 0.94, 10.3); p = 0.06). Similarly, grade2+ leukopenia (HR:9.98 (95%CI: 1.14, 86.6); p = 0.03), lymph-node positivity (HR:14.6 (95%CI:1.0, 214.4); p = 0.05) and vaginal involvement (HR:5.81 (95%CI:1.43, 23.6); p = 0.01) impacted on overall survival, at multivariate analysis. Magnitude of leukopenia correlated with survival (p<0.001). Conclusions Although, our data have to be confirmed by prospective investigations, the present study shows an association between the occurrence of leukopenia and survival outcomes. NACT-related immunosuppression might reduce the response against the tumor, thus promoting cancer progression.

AB - Objective To investigate the impact of hematologic toxicity and leukopenia in locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy (NACT). Study design Data of consecutive patients undergoing platinum-based NACT followed by surgery were retrospectively searched in order to evaluate the impact of chemotherapy-related toxicity on survival outcomes. Toxicity was graded per the Common Terminology Criteria for Adverse Events (CTCAEv.4.03). Survival outcomes were evaluated using Kaplan-Meir and Cox hazard models. Results Overall, 126 patients were included. Among those, 94 (74.6%) patients experienced grade2+ hematologic toxicity; while, grade2+ non-hematologic toxicity occurred in 11 (8.7%) patients. After a median follow-up of 37.1 (inter-quartile range, 12–57.5) months, 21 (16.6%) patients experienced recurrence. Via multivariate analysis, no factor was independently associated with disease-free survival; while a trend toward worse prognosis was observed for patients experiencing grade2+ leukopenia at cycle-3 (HR:3.13 (95%CI: 0.94, 10.3); p = 0.06). Similarly, grade2+ leukopenia (HR:9.98 (95%CI: 1.14, 86.6); p = 0.03), lymph-node positivity (HR:14.6 (95%CI:1.0, 214.4); p = 0.05) and vaginal involvement (HR:5.81 (95%CI:1.43, 23.6); p = 0.01) impacted on overall survival, at multivariate analysis. Magnitude of leukopenia correlated with survival (p<0.001). Conclusions Although, our data have to be confirmed by prospective investigations, the present study shows an association between the occurrence of leukopenia and survival outcomes. NACT-related immunosuppression might reduce the response against the tumor, thus promoting cancer progression.

KW - Cervical cancer

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KW - Neoadjuvant chemotherapy

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