3780 - Subsystem Level Analysis of Allostatic Load in Locally Advanced Cervical Cancer Patients Treated with Definitive Chemoradiation

Purpose/Objective(s): Allostatic load (AL), a measure of cumulative physiologic stress, has been associated with worse outcomes in multiple cancers, yet its association with recurrence in cervical cancer remains unclear. We aim to calculate AL and evaluate its association with tumor control and longitudinal change in a diverse population treated across private and public hospitals.

Materials/Methods: We conducted a retrospective cohort analysis in patients with locally advanced cervical cancer treated with definitive chemoradiation at the University of Miami and Jackson Health System (September 2013 - April 2025). AL was calculated at three timepoints (baseline, early treatment, and 12 months post-treatment) using quartiles across 14 biomarkers representing 4 physiologic subsystems: cardiovascular (HR, SBP, DBP), metabolic (BMI, ALP, albumin, glucose), renal (creatinine, BUN), and hematologic (WBC, ANC, Hgb, PLT). Racial differences, AL trajectories, and recurrence associations were analyzed using Kruskal-Wallis and Mann-Whitney U tests with longitudinal pattern classification.

Results: 71 patients were included. The cohort was predominantly White (64.8%, n=46) and Black (26.8%, n=19), with a median age of 49 years (range 27-80, SD 12.6). Most identified as Hispanic or Latino (63.4%, n=45). 81.7% (n=58) had squamous cell carcinoma, followed by adenocarcinoma (7.0%), small cell carcinoma (2.8%), and adenosquamous carcinoma (2.8%). FIGO stages included I (5.6%), II (49.3%), III (35.2%), and IV (7.0%). Recurrence patterns were predominantly distant metastases (19.7%, n=14), followed by locoregional (7.0%, n=5) and local recurrence (5.6%, n=4). Patients who recurred were younger (mean 43.9 ± 9.0 years) than those without recurrence (mean 50.5 ± 13.2 years; p=0.065).

Baseline AL was not associated with recurrence: p=0.915. Change in AL from baseline to early treatment was not associated with recurrence (p=0.749). Loss to follow-up and incomplete AL markers precluded analysis of 1-year post-treatment AL change and its impact on recurrence. However, baseline cardiovascular AL markers demonstrated a racial disparity among Black patients (p=0.0103). While total AL (all subsystems combined) trended toward a disparity in Black patients but was not significant (p=0.105), FIGO stage reliably predicted recurrence (p=0.0013).

Conclusion: In this cohort analysis of locally advanced cervical cancer patients, baseline and early AL were not associated with recurrence. Of note, black patients demonstrated higher baseline AL for cardiovascular-specific AL markers. This subsystem-level analysis highlights the potential for personalized cardiac AL stratification and subsequent stress-reducing intervention. A lack of consistent post-treatment AL markers precluded a larger analysis of AL changes over time and their associations with recurrence. Prospective studies are needed to better understand the impact of AL and its changes over the treatment course, including recurrence, in LACC.