Objective  To explore the influencing factors of the efficacy of programmed death-1 (PD-1) inhibitor pembrolizumab in the treatment of cervical cancer.

Methods The clinical data of cervical cancer patients admitted to the Department of Obstetrics and Gynecology of Anhui Women and Children's Medical Center from January 2020 to October 2023 were retrospectively analyzed and the patients were divided into the ineffective group and the effective group according to the pembrolizumab treatment efficacy. The clinical data of patients in the two groups were compared [age, tumor type, pathological type, lesion size, differentiation degree, number of pregnancies, number of births, number of miscarriages, menopausal status, tumor mutation load (TMB), DNA repair gene mutation status, PD-L1 expression, diabetes mellitus, hypertension, mode of treatment, body mass index, tumor-infiltrating lymphocyte (TIL) expression, neoantigen intra-tumor heterogeneity (ITH) status, presence of liver disease, and family history], and logistic regression analysis was used to determine the risk factors affecting the efficacy of pembrolizumab in cervical cancer patients.

Results  A total of 60 patients were included in the study, with 42 in the effective group and 18 in the ineffective group. The proportion of patients with TMB<143/Mb, no mutation in DNA repair genes, low expression of PD-L1, simple immunotherapy, TIL negative, and high PTH in the ineffective group was higher than that in the effective group (P<0.05). Multivariate Logistic regression analysis showed that TMB<143/Mb, non-mutated DNA repair genes, low PD-L1 expression, simple immunotherapy, TIL negative, and high PTH were risk factors affecting the efficacy of pembrolizumab in cervical cancer patients (P<0.05).

Conclusion  The efficacy of the PD-1 inhibitor pembrolizumab in cervical cancer patients is influenced by factors such as TMB, DNA gene mutations, PD-L1 expression, treatment mode, TIL, and ETH.

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