SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1676838
This article is part of the Research TopicAdvances in the Understanding of the Immune System Relationship with Neoplasia and Immuno-oncology ApproachesView all articles
Can posttreatment blood inflammatory markers predict poor survival in gynecologic cancer?: A systematic review and meta-analysis
Provisionally accepted
- 1Catholic University of Korea, Seoul, Republic of Korea
- 2Department of Radiation Oncology, The Catholic University of Korea Eunpyeong St Mary's Hospital, Eunpyeong-gu, Republic of Korea
- 3Department of Hospital Pathology, The Catholic University of Korea Eunpyeong St Mary's Hospital, Eunpyeong-gu, Republic of Korea
- 4Department of Hospital Pathology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
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Introduction: Peripheral blood inflammatory markers (PBIMs) are widely used for prognostication of several malignancies, including gynecologic cancers. However, most studies do not report when PBIMs have been sampled, and the ones that do usually use pretreatment levels. Considering their potential to reflect the host immune status, posttreatment PBIMs and their dynamic changes from pretreatment levels may also carry prognostic information. A systematic review and meta-analysis were conducted to identify the prognostic value of posttreatment PBIMs and their dynamic changes from baseline in gynecologic cancers. Furthermore, among the inconsistent blood draw timing and analytical methods, we aimed to suggest the most suitable strategies in the clinical setting. Methods: Fourteen eligible studies comprising 2,373 patients with cervical, ovarian, or endometrial cancer were included. The associations between survival outcomes, including overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS), and the PBIMs were extracted or estimated. The PBIMs included the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), the systemic immune-inflammation index (SII), and the systemic inflammation response index (SIRI). Subgroup analyses examined early versus late posttreatment sampling, as well as dynamic assessments based on threshold-defined change (increase or decrease) versus simple directional change (high or low). Results: All PBIMs (NLR, PLR, MLR, SII, and SIRI) demonstrated significant association with relevant survival endpoints (OS, PFS, and DFS). Early sampling of within one month after treatment completion (≤ median 15 days) showed prognostic significance (pooled hazard ratios 3.43–3.55; p < 0.0001), whereas late sampling demonstrated no significant
Keywords: Systematic reviews, Genital neoplasms, female, peripheral blood inflammatory marker, Neutrophil lymphocyte ratio, Posttreatment, Dynamic change
Received: 31 Jul 2025; Accepted: 08 Oct 2025.
Copyright: © 2025 Choi, Lee, Lee and Yim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kwangil Yim, kangse_manse@catholic.ac.kr
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