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

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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.

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