Exploratory Analysis of Systemic Inflammatory Indices Across Locoregional Tumor Progression Parameters in Cervical Cancer: The CERTIFIKO Prospective Study

Background and Objectives: Systemic inflammatory indices derived from routine blood tests have been proposed as potential biomarkers reflecting tumor behavior. This study aimed to evaluate their association with parameters of locoregional tumor progression in cervical cancer. Materials and Methods: This prospective observational study (CERTIFIKO) included 79 patients with cervical cancer enrolled between July 2023 and December 2025. This study was registered on ClinicalTrials.gov (NCT05673252). Pre-treatment blood samples were used to calculate the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response (SIR), and systemic inflammatory response index (SIRI). Tumor progression parameters included stromal infiltration, parametrial involvement, lymphovascular space invasion (LVSI), fornix involvement, lymph node status, histotype, and grading. Associations were assessed using non-parametric tests and linear regression models. Results: Stromal infiltration was significantly associated with PLR (p = 0.011), MLR (p = 0.010), and NLR (p = 0.010). Parametrial involvement was associated with MLR (p = 0.004) and NLR (p = 0.012). Diffuse LVSI was associated with PLR (p = 0.002), NLR (p = 0.006), SIR (p = 0.008), and SIRI (p = 0.034). In multivariable linear regression models, diffuse LVSI remained associated with higher PLR and NLR values, whereas parametrial involvement remained associated with higher MLR, NLR, and SIRI. No significant associations were observed for fornix involvement, histotype, or lymph node status. Conclusions: Systemic inflammatory indices were associated with parameters of locoregional tumor progression in this exploratory cohort of patients with cervical cancer. These findings warrant further evaluation in larger studies before any potential clinical application.