Abstract
AIMS: Despite progress in chemoradiotherapy (CRT), outcomes in cervical cancer still vary widely. Minimally invasive biomarkers may enable risk stratification and treatment optimization. METHODS: We prospectively enrolled 164 International Federation of Gynecology and Obstetrics (FIGO) IB-IVA patients, all receiving CRT plus brachytherapy. Baseline blood markers and HPV subtypes were assessed. Treatment response was evaluated at three months, and progression-free (PFS) and overall survival (OS) were measured over a median of 36 months. RESULTS: Elevated squamous cell carcinoma antigen (SCC-Ag), Cancer antigen 125 (CA125), Interleukin-6 (IL-6), C-reactive protein (CRP), and high neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (NLR/PLR) correlated with advanced disease. At three months, 87.1% showed complete response (CR) or partial response (PR). Higher IL-6, CRP, SCC-Ag, CA125, and NLR/PLR were linked to poorer response. At 36 months, PFS and OS were 65.2% and 74.5%, respectively. High-risk patients had lower PFS (58.1% vs. 72.4%) and OS (64.5% vs. 82.0%), independent of stage, with no increase in severe toxicity. CONCLUSIONS: A multi-biomarker panel shows superior discrimination for early response and is prognostic for survival in locally advanced cervical cancer. Larger, multi-institutional studies are warranted to validate this panel, standardize assays, and investigate additional markers or imaging-based strategies, ultimately facilitating more personalized therapy and improved outcomes. shows superior discrimination for early response and is prognostic for survival in locally advanced cervical cancer.