- blood mean platelet volume/platelet count ratio (MPV/PC) in patients with resectable cervical. - Objective: To evaluate the prognostic value of MPV/PC in cervical cancer patients.. - Methods: This study enrolled 408 patients who had undergone radical surgery for cervical cancer and evaluated the correlation of MPV/PC with patient prognosis in the primary cohort and validation cohort. - Additionally, independ- ent prognostic factors were incorporated to construct the prognostic nomogram, and the area under the receiver operating characteristic (ROC) curve (AUC) value was calculated to analyze the prognostic predictive ability of the nomogram.. - Results: In the primary cohort, Kaplan–Meier survival analysis indicated that the overall survival (OS) for patients with MPV/PC ≤ 0.41 was significantly lower than that in patients with MPV/PC >. - MPV/PC was an independent prog- nostic factor for resectable cervical cancer patients. - Compared with neutrophil/lymphocyte ratio (NLR), platelet/lym- phocyte ratio (PLR) or monocyte/lymphocyte ratio (MLR), the AUC values of MPV/PC in predicting the 3- and 5-year survival rates for cervical cancer patients were greater. - Similar results were verified in the validation cohort. - Subse- quently, the nomogram constructed based on MPV/PC, International Federation of Gynecology and Obstetrics (FIGO) classification and lymphovascular invasion performed well to accurately predict the prognosis of cervical cancer patients. - Similar results were also displayed in the validation cohort.. - Conclusions: MPV/PC may be used as a novel independent prognostic factor for patients with resectable cervical cancer. - Compared with the FIGO classification system, the nomogram integrating MPV/PC maybe reliably predict the survival of cervical cancer patients after radical surgery.. - The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - The morbidity and mortality of cervical cancer rank 4th among female malignant tumors worldwide [1]. - Glob- ally, approximately 527,600 new cervical cancer cases and 265,700 cervical cancer-related deaths are reported annually [1]. - According to statistics, 98,900 new cervical cancer cases and 30,500 deaths occurred in China in 2015 [2]. - Currently, the International Federa- tion of Gynecology and Obstetrics (FIGO) classification system is mainly used to judge the clinical prognosis of cervical cancer. - Recent studies have indicated that the MPV/PC ratio based on the mean platelet volume (MPV) and platelet count (PC) can predict the prognosis of multiple malignant tumors [6–12]. - However, the prognostic value of MPV/PC in cervical cancer has not yet been investigated. - Therefore, this study aimed to explore the influencing factors for the prognosis of cervical cancer patients, evaluate the prog- nostic values of MPV/PC, NLR, PLR and MLR in cervical cancer, and construct a prognostic nomogram for resect- able cervical cancer patients on this basis. - Additionally, the prognostic prediction accuracy of this model was compared with that of the FIGO classification system to guide clinical practice and improve the clinical outcomes of cervical cancer patients.. - Together, 283 patients who received radical surgery for cervical cancer at the Second Affiliated Hospital of Soochow University from 2009 to 2017 were retrospec- tively analyzed. - Additionally, 125 cervi- cal cancer patients who had undergone radical resection at the Kunshan First People’s Hospital were recruited as the validation cohort. - The study design conformed to the Declaration of Helsinki and was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University (2009-KY-043). - The clinical information, clinicopathological parame- ters and preoperative routine blood tests of the patients were collected. - Table 1 Clinicopathological characteristics of patients with cervical cancer in primary cohort and validation cohort. - The routine blood tests at 1 week before surgery included those to evalu- ate WBC, Hb, monocytes, neutrophils, lymphocytes, PC, MPV and the platelet distribution width (PDW), along with NLR, PLR, MLR and MPV/PC calculated based on the abovementioned results. - To evaluate the discriminating ability of MPV/PC, NLR, PLR and MLR in cervical cancer prog- nosis, ROC curves were plotted to preliminarily evalu- ate the area under the curve (AUC). - MPV/PC mean platelet volume/platelet count, NLR neutrophil lymphocyte ratio, PLR platelet lymphocyte ratio, MLR monocyte lymphocyte ratio. - MPV/PC ≤ 0.41. - (141) MPV/PC>0.41. - 1 Kaplan–Meier curves for cervical cancer patients stratified by (A) MPV/PC, B NLR, C PLR and D MLR in the primary cohort. - The predictive ability of MPV/PC in cervical cancer patients was compared with NLR, PLR and MLR using ROC curves at 3 years (E) and 5 years (F) in the primary cohort. - 2 Kaplan–Meier curves for cervical cancer patients stratified by (A) MPV/PC, B NLR, C PLR and D MLR in the validation cohort. - The predictive ability of MPV/PC in cervical cancer patients was compared with NLR, PLR and MLR using ROC curves at 3 years (E) and 5 years (F) in the validation cohort. - Cox model were used to construct the nomogram. - Typi- cally, the C-index and AUC were mainly used to assess the performance of the nomogram. - The rms module of the R pro- gramming language, SPSS 22.0 and GraphPad Prism 5 were employed for statistical analysis. - In total, 408 cervical cancer patients who had undergone radical surgery were enrolled in this study. - The clinico- pathological features of patients in the primary cohort (n = 283) and validation cohort (n = 125) are displayed in Table 1. - In the primary cohort, the median patient age was 47 (range, 24–84) years. - In the validation group, the median follow-up period was 47 (range, 3–120) months, and the median patient age was 43 (range, 24–67). - The optimal cut-off value based on the primary cohort was were selected by ROC curve analysis as fol- lows: MPV/PC (MPV/PC ≤ 0.41, MPV/PC >. - The clinicopatholog- ical features of patients in the two cohorts were compara- ble, except for the tumor invasion depth. - The correlations of MPV/PC with the clinicopathological features of cer- vical cancer patients are displayed in Table 2. - In the pri- mary cohort, MPV/PC was only negatively correlated with PLR (P = 0.007) but not related to other pathological parameters. - Similar results were also obtained in the vali- dation cohort.. - In the primary cohort, the Kaplan–Meier survival curves of the MPV/PC, NLR, PLR and MLR indices are presented in Fig.1A-D. - PC ≤ 0.41 was significantly lower than that of patients with MPV/PC >. - Additionally, Table 3 Univariate and multivariate cox regression analyses for overall survival in cervical cancer patients in primary cohort. - MPV/PC. - the NLR, PLR and MLR indices may be used to evalu- ate the prognosis of cervical cancer patients, and the differences were statistically significant (Fig. - Sub- sequently, the prognostic values of the 4 indices were compared using the AUC value. - Compared with other systemic inflammatory indices, the MPV/PC index dis- played greater AUC values in predicting the 3- and 5-year survival rates for cervical cancer patients, indicating that MPV/PC had better prognostic value than NLR, PLR or MLR for cervical cancer patients (Fig. - Addition- ally, similar results were also obtained in the validation cohort (Fig. - In the primary cohort, the univariate Cox proportional hazard regression model indicated that tumor invasion depth, tumor size, lymphovascular invasion, FIGO stage, MPV/PC, NLR, PLR and MLR were prognostic factors for cervical cancer patients (Table 3). - The multivari- ate Cox proportional hazard regression model indicated that lymphovascular invasion, FIGO stage and MPV/PC were independent prognostic factors for cervical cancer. - In the validation cohort, tumor inva- sion depth was not significantly related to the prognosis of cervical cancer patients, a finding that might be related to the small sample size. - The other results were consist- ent with those obtained in the primary cohort (Table 4).. - Construction and validation of the nomogram. - In the primary cohort, independent risk factors for cer- vical cancer, including MPV/PC, FIGO stage and lym- phovascular invasion, were used to construct nomogram models to predict the 3- and 5-year OS of cervical can- cer patients (Fig. - The C-index of the as-constructed nomogram was 0.77, significantly higher than the 0.68 of the FIGO stage (P <. - AUC analysis revealed that the AUC value of the nomogram was significantly greater than that of the FIGO stage (Fig. - 4A and B), indi- cating that the nomogram might be used to assess the prognosis for patients with resectable cervical cancer and that it was more accurate than the traditional FIGO stage. - In internal verification, the calibration curve of the. - Table 4 Univariate and multivariate cox regression analyses for overall survival in cervical cancer patients in validation cohort. - 4C-D), demonstrating the extremely reliable repeatability of the nomogram. - Fur- thermore, external verification of the nomogram was conducted using the validation cohort data. - The C-index of the nomogram was 0.82, which was significantly higher than the 0.72 of FIGO stage (P <. - The AUC value of the nomogram was apparently higher than that of the FIGO classification system (Fig. - Addi- tionally, the calibration curve of the nomogram showed good consistency between the predicted 3−/5-year sur- vival rates and actual observed values (Fig. - The above results suggested that the nomogram might serve as a tool to predict the survival of patients more effectively and accurately with resectable cervical cancer.. - Since scholars first reported the increased platelet count in cancer patients in the platelet changes in blood from patients with malignant tumors at different sites have been successively investigated. - Platelets are one of the bioactive visible blood components produced by mature megakaryocytes in bone marrow and affect the inflammatory response and immune regulation in the. - Platelets extensively exist in the peripheral blood circulation and exert their role in tumor invasion, hematogenous metastasis and distal organ coloniza- tion through surface molecules or secreting related fac- tors [16, 17]. - PC and MPV are the two most important indices to evaluate platelet function, and their combina- tion in the MPV/PC index has recently been used in the prognosis evaluation of malignant tumor patients. - revealed the expression level and diagnostic value of MPV/PC in hepatocellular carcinoma (HCC) patients [6]. - found that the OS of HCC patients with high MPV/PC was significantly poorer [11].. - We confirmed that cervical cancer patients with high MPV/PC had a poor prognosis, and MPV/PC Fig. - 3 Nomogram based on MPV/PC, LVI and FIGO in cervical cancer. - was an independent prognostic factor for cervical cancer patients. - The ROC curve revealed that MPV/PC showed higher prognostic value than NLR, PLR and MLR in cer- vical cancer. - The nomogram exhibited a high accuracy in predicting survival (C-index = 0.78) and a significantly higher predictive ability in the survival of the primary cohort than the FIGO classification system.. - MPV/PC may serve. - Bone marrow hyper- plasia is active in malignant tumor patients, tumor cells produce thrombogenic factors, and the body fluid envi- ronment concentration that promotes the generation of bone marrow megakaryocytes is elevated in the blood Fig. - 4 The 3-year survival rate (A) and 5-year survival rate (B) of cervical cancer patients predicted by the nomogram were highly consistent with the actual observed values in the primary cohort. - Ability of the ROC analysis nomogram to predict the 3-year survival rate (C) and 5-year survival rate (D) of cervical cancer patients. - The nomogram had a larger AUC than FIGO staging in the primary cohort. - 5 The 3-year survival rate (A) and 5-year survival rate (B) of cervical cancer patients predicted by the nomogram were highly consistent with the actual observed values in the validation cohort. - The nomogram had a larger AUC than FIGO staging in the validation cohort. - (2) Heterogeneity existed in the treatments that patients received after surgical resection, likely affecting different clinical outcomes.. - As a noninvasive, lost-cost, simple and repeatable index, MPV/PC is a novel independent prognostic index for patients with resectable cervical cancer. - Compared with the traditional FIGO classification system, the nomo- gram that integrates MPV/PC maybe reliably predict the survival of cervical cancer patients after radical surgery.. - This study was carried out in accordance with the principles of the Declaration of Helsinki, and approval was obtained from the institutional review boards at the Ethics Committee of The Second Affiliated Hospital of Soochow University (2009-KY-043). - Written informed consent was obtained from all patients included in the study.. - A novel prognostic marker systemic inflammation response index (SIRI) for operable cervical Cancer patients.. - Prognostic impact of the mean platelet volume/platelet count ratio in terms of survival in advanced non-small cell lung cancer. - Combined use of mean platelet volume/platelet count ratio and platelet distribution width to distinguish between patients with nasopharyngeal carcinoma, those with benign tumors of the Nasopharynx, and healthy subjects. - CXCR4: a key receptor in the crosstalk between tumor cells and their microenvironment
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