3743 - Allostatic Load as a Predictor of Outcomes in Cervical Cancer Patients Receiving Definitive Chemoradiotherapy
Presenter(s)
D. K. Dietrich1, S. Ansari2, S. Kalidoss1, P. N. Copeland1, S. M. Lee3, R. Zitter4, and Y. Hasan4; 1University of Chicago Pritzker School of Medicine, Chicago, IL, 2Northwestern University, Chicago, IL, 3University of Chicago Department of Public Health Sciences Biostatistics Library, Chicago, IL, 4Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
Purpose/Objective(s):
Allostatic load (AL) reflects cumulative biologic damage from chronic socioenvironmental stress across cardiovascular, metabolic, and immune domains. Prior studies suggest AL predicts cancer risk and mortality. This is the first study evaluating AL in cervical cancer (CC) patients treated with definitive chemoradiotherapy (CRT). We hypothesized higher AL would be associated with advanced stage, recurrence, treatment failure, and worse overall survival (OS).Materials/Methods:
We retrospectively analyzed CC patients treated from 2001–2023 at a single institution. AL was calculated using biomarkers obtained within 9 months of diagnosis (closest value used): systolic/diastolic blood pressure, heart rate, body mass index, glucose, white blood cell count, alkaline phosphatase, albumin, creatinine, and blood urea nitrogen. Using cohort quartiles, one point was assigned per biomarker in the high-risk quartile (=75th percentile; albumin =25th percentile) and points were summed for total AL. Logistic regression evaluated AL with binary FIGO 2018 stage (I–II vs III–IV), recurrence, and treatment failure. Cox regression assessed AL with OS. Multivariable models adjusted for age, stage, race, and smoking (stage excluded from the AL-stage model). Kaplan-Meier curves assessed median survival and OS.
Results:
Among 119 patients, mean age was 54.3 years (SD 14.3); 54% were Black and 36% White. Histology was predominantly squamous cell (85%). Stage distribution was 6% I, 26% II, 43% III, and 25% IV (FIGO 2018). Most received single-agent cisplatin (83%; mean 4.9 cycles). Biomarkers were obtained a median of 17 days from diagnosis (IQR 38).
Mean AL was lower in early- versus advanced-stage disease (2.32 vs 2.97). AL was not associated with stage, recurrence, or treatment failure in univariate or multivariate models. However, AL was significantly associated with OS: each 1-point increase conferred a 20% higher risk of death on univariate analysis (HR 1.20, 95% CI 1.05–1.38, p=0.009) and remained significant on multivariable analysis (HR 1.16, 95% CI 1.002–1.351, p=0.047). In stage I–II patients, AL <2 was associated with improved median OS compared to AL =2 (204.2 vs 46.5 months; log-rank p=0.057). Five-year OS was 85.6% versus 42.5%, respectively.
Conclusion:
Higher AL was independently associated with worse OS in CC patients treated with CRT, despite no association with stage, recurrence, or treatment failure. AL may identify physiologic vulnerability influencing long-term survival beyond oncologic factors and warrants validation in larger cohorts to guide general health-focused care for early-stage patients at high risk for mortality.