| Sumario: | Simple Summary: Small cell neuroendocrine carcinoma of the cervix (SCNEC) is an uncommon but highly aggressive cancer with limited prognostic indicators to guide clinical decisions. Routine blood tests contain valuable information that may reflect the body's immune and inflammatory response to cancer. In this study, we analyzed blood-derived inflammatory markers in patients with SCNEC and identified the monocyte-to-lymphocyte ratio (MLR) as a promising indicator of disease progression. We further developed a prediction tool, known as a nomogram, that estimates each patient's likelihood of remaining progression-free at 3 and 5 years. This model demonstrated strong accuracy and may serve as a convenient and cost-effective aid for individualized risk assessment and treatment planning in clinical practice. Our findings highlight the potential of simple blood-based biomarkers to improve personalized management for patients with this rare and challenging disease. Background: Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a rare and highly aggressive malignancy with limited prognostic biomarkers available for clinical use. Inflammatory markers derived from complete blood count (CBC) have been shown to reflect the systemic immune response and tumor progression in various cancers, but their prognostic value in SCNEC remains unclear. Methods: We retrospectively analyzed clinical data from patients diagnosed with SCNEC between 2004 and 2024 across two centers. Internal validation was performed by dividing patients into training and test cohorts. Cox regression analyses and Kaplan–Meier survival analyses were used to evaluate prognostic factors and treatment outcomes. Inverse probability of treatment weighting (IPTW) was applied to reduce baseline imbalances. Patients were randomly divided into training and test cohorts. A nomogram was constructed to predict 3-year and 5-year progression-free survival (PFS) with performance evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results: 196 participants were included in the study. Age, FIGO 2018 stage, surgery, neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) were independently associated with PFS. High MLR (>0.19) was significantly linked to shorter PFS. After IPTW adjustment, the protective effect of low MLR on PFS remained significant (p = 0.029). The constructed nomogram demonstrated excellent predictive performance, with area under the curve (AUC) values of 0.799 and 0.787 for 3-year and 5-year PFS in the training cohort, and 0.802 for endpoints in the test cohort. Conclusions: MLR was identified as an independent prognostic biomarker for PFS in SCNEC, with potential value in risk stratification and personalized treatment strategies. Additionally, we developed a reliable nomogram that accurately predicts 3-year and 5-year PFS, serving as a practical tool for individualized prognosis and clinical decision-making.
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