Beyond conventional staging: prognostic significance of systemic inflammatory indices at diagnosis in malignant peripheral nerve sheath tumors

Öz

Aim: Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are rare soft tissue sarcomas characterized by aggressive behavior and high recurrence rates. Conventional TNM staging may sometimes be insufficient to predict survival differences among patients with a similar tumor burden. The aim of this study was to investigate the prognostic value of systemic inflammatory indices at diagnosis in patients with MPNST and to determine whether these indices represent prognostic biomarkers independent of classical prognostic factors. Materials and Methods: A total of 43 patients with histopathologically confirmed MPNST were retrospectively analyzed. Demographic characteristics, tumor-related features, and inflammatory indices derived from pretreatment complete blood count parameters were recorded. Factors affecting overall survival (OS) were evaluated using Kaplan–Meier survival analysis and Cox proportional hazards regression models. Results: At the end of the median follow-up period, the median OS for the entire cohort was 25.7 months. In univariate analyses, the presence of metastasis (p = 0.005), a high platelet-to-lymphocyte ratio (PLR) (p < 0.001), and a high systemic immune-inflammation index (SII) (p = 0.012) were significantly associated with poor survival, whereas tumor size–based T stage (T1–T2 vs. T3–T4) did not show a significant impact on survival (p = 0.446). In multivariate Cox regression analysis, even after adjustment for metastatic status and T stage, high PLR (hazard ratio [HR]: 3.61, 95% confidence interval [CI]: 1.53–8.50, p = 0.003) and high SII (HR: 2.95, 95% CI: 1.35–6.44, p = 0.006) remained independent and strong risk factors for OS. Conclusion: PLR and SII at diagnosis are simple, readily available, and powerful prognostic biomarkers in patients with MPNST, independent of tumor burden as reflected by T stage. These indices may assist clinicians in identifying high-risk patients beyond conventional staging systems and may contribute to the personalization of treatment strategies.

Anahtar Kelimeler

• malignant peripheral nerve sheath tumor
• platelet-to-lymphocyte ratio
• systemic immune-inflammation index
• prognosis

Geleneksel evrelemenin ötesinde: malign periferik sinir kılıfı tümörlerinde tanı anındaki sistemik enflamatuar indekslerin prognostik önemi

Öz

Amaç: Malign Periferik Sinir Kılıfı Tümörleri (MPNST), agresif seyirli ve yüksek nüks oranına sahip nadir yumuşak doku sarkomlarıdır. Klasik TNM evrelemesi, benzer tümör yüküne sahip hastalardaki sağkalım farklılıklarını öngörmede bazen yetersiz kalmaktadır. Bu çalışmanın amacı, tanıdaki sistemik inflamatuvar indekslerin MPNST hastalarındaki prognostik değerini araştırmak ve klasik prognostik faktörlerden bağımsız birer belirteç olup olmadıklarını ortaya koymaktır. Gereç ve Yöntemler: Histopatolojik olarak MPNST tanısı alan 43 hasta retrospektif olarak incelendi. Hastaların demografik verileri, tümör özellikleri ve tedavi öncesi hemogram parametrelerinden türetilen inflamatuvar indeksler kaydedildi. Genel sağkalımı (OS) etkileyen faktörler Kaplan-Meier ve Cox regresyon analizleri ile değerlendirildi. Bulgular: Medyan takip süresi sonunda tüm kohort için medyan sağkalım 25,7 aydı. Tek değişkenli analizlerde metastaz varlığı (p = 0,005), yüksek platelet/lenfosit oranı (PLR) (p < 0,001) ve yüksek sistemik inflamatuvar indeks (SII) (p = 0,012) kötü sağkalım ile ilişkili bulunurken; tümör boyutuna dayalı T evresinin (T1-T2 vs T3-T4) sağkalım üzerinde anlamlı bir etkisi izlenmedi (p = 0,446). Çok değişkenli Cox regresyon analizinde; metastaz durumu ve T evresi için düzeltme yapıldığında dahi, yüksek PLR (HR: 3,61, %95 CI: 1,53-8,50, p = 0,003) ve yüksek SII (HR: 2,95, %95 CI: 1,35-6,44, p = 0,006) genel sağkalım için bağımsız ve güçlü birer risk faktörü olarak saptandı. Sonuçlar: Tanıdaki PLR ve SII, MPNST hastalarında tümör yükünden (T evresi) bağımsız, kolay uygulanabilir ve güçlü prognostik biyobelirteçlerdir. Bu indeksler, klasik evreleme sistemlerinin ötesinde yüksek riskli hastaların belirlenmesinde ve tedavi stratejilerinin kişiselleştirilmesinde klinisyenlere rehberlik edebilir.

Anahtar Kelimeler

• malign periferik sinir kılıfı tümörü
• trombosit-lenfosit oranı
• sistemik immün-enflamasyon indeksi
• prognoz

Kaynakça

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