Development and validation of a Comprehensive Hematological Scoring System for predicting overall survival in patients with soft tissue sarcomas: a comparison with NLR and PLR

Ying Qiu ¹, Jiquan Liu ¹, Shuang Chai ¹

⁰Department of Orthopedics, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan, China.

Frontiers in Oncology +

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August 18, 2025

View abstract on PubMed

Summary

A new Composite Hematological Scoring System (CHSS) offers superior prognostic value for soft tissue sarcoma (STS) patients compared to existing biomarkers. This scoring system aids in predicting overall survival and personalizing treatment strategies for rare cancers.

Area Of Science

Oncology
Hematology
Biostatistics

Background

Soft tissue sarcomas (STS) are rare malignancies with poor prognoses and limited treatment options.
Existing biomarkers like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have insufficient prognostic accuracy.
There is a need for more comprehensive biomarkers to predict outcomes in STS patients.

Purpose Of The Study

To develop and validate a Composite Hematological Scoring System (CHSS) for improved prognostic stratification of STS patients.
To compare the prognostic performance of CHSS against established biomarkers (NLR, PLR).
To integrate CHSS into a nomogram for clinical application in personalized STS management.

Main Methods

Retrospective analysis of 206 STS patients (2016-2023).
Development of CHSS using LASSO regression on 19 pretreatment markers, including glucose, CRP, LDL-C, HDL-C, albumin, platelets, hemoglobin, and lymphocytes.
Prognostic evaluation using Kaplan-Meier, time-dependent ROC, and Cox regression; nomogram validation via C-index and calibration.

Main Results

CHSS demonstrated superior prediction of overall survival (OS) compared to NLR and PLR.
High CHSS scores significantly correlated with worse OS (HR=6.197, P<0.001).
CHSS, age, tumor size, and FNCLCC grade were independent predictors; the nomogram showed good predictive accuracy (C-index=0.79).

Conclusions

CHSS offers enhanced prognostic stratification for STS by integrating inflammation, metabolism, and nutrition markers.
The CHSS-based nomogram can aid in personalized management strategies for STS patients.
Multicenter validation is recommended to confirm the generalizability of the CHSS findings.

Keywords:

Comprehensive Hematological Scoring System (CHSS) neutrophil-to-lymphocyte ratio (NLR) platelet-to-lymphocyte ratio (PLR) prognosis soft tissue sarcoma (STS)