Evaluation of Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence

Abstract

Background: Immune system status is a factor related to cervical intraepithelial neoplasia (CIN) recurrence. neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immune status. The aim of this study was to evaluate the prognostic value of NLR factor for CIN recurrence in patient who underwent excisional procedure and its relationship with recurrence free survival (RFS). Methods: In this historical cohort study, a population of 307 patients with CIN (confirmed by excisional pathology) from 2009 to 2017 were selected. NLR and hematologic factors were measured before surgery and the follow-up records of these patient were analyzed. The recurrence rate and RFS were assessed during the follow-up phase. Results: The NLR cutoff point of 1.9 was determined using the Youden Index. NLR<1.9 (low NLR) and NLR≥1.9 (high NLR) were observed among 68.1% and 39.1% of patients, respectively. Univariate analysis showed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) and platelet lymphocytic ratios (PLR) (P=0.002) were significantly associated with reduction in RFS. The results of Cox regression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136) significantly reduced the hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and white blood cell (WBC) count levels (HR =1.27; 95% CI, 1.04-1.55), significantly decreased RFS, but PLR and ANC associated with RFS were not confirmed by Cox regression. Conclusion: NLR and total WBC count might be prognostic factors involved in the prediction of recurrence and RFS in CIN patient underwent excisional procedure. To confirm these results, more prospective studies with larger sample sizes are needed.

The effects of vitamin B12, vitamin D, ferritin level, neutrophil/monocyte ratio and some blood parameters on genital warts presence, the number of lesions, and recurrence rates

“…The most important difference of our study from the ones in the literature is that patients who have just been met to the virus and have not yet developed malignancy were included in our study, while the patients who have already developed malignancy had been analysed in other studies in the literature. The reason for the difference in the results of some studies in the literature may be that patients with malignancies of different stages and sizes were included in those studies (Huang et al., 2015; Chun et al., 2017; De Felice et al., 2019; Li et al., ,2016, 2017; Wu et al., 2017; Farzaneh et al., 2019).…”

Bioinformatics analysis and identification of potential genes related to pathogenesis of cervical intraepithelial neoplasia

“…Previous studies have focused on different types of solid tumors (cervical cancer), such as genetic instability at gene locus 1p36, which may be a feature of cervical cancer 22 ; decreased expression of cytokeratin 7 may lead to poor prognosis of cervical cancer 23 ; HPV infection is an important potential biomarker of cervical cancer 24 ; neutrophil ratio and white matter cell count can be used as a prognostic factor for recurrence of cervical cancer 25 . However, the continuous process from inflammation to CIN to invasive cancer is often overlooked.…”

Prognostic Implications of Immune-Related Genes’ (IRGs) Signature Models in Cervical Cancer and Endometrial Cancer

“…It is also reported that ( Wisdom et al, 2019 ) neutrophils can increase the resistance of tumor cells to radiation therapy, and neutrophil-lymphocyte ratio can be considered as a predictor in stage IVB or recurrent cervical cancer patients treated by chemotherapy. Neutrophil-lymphocyte ratio ≥ 3.6 has been identified as an independent predictor of poor oncologic outcomes with respect to OS ( Farzaneh et al, 2019 ; Ittiamornlert and Ruengkhachorn, 2019 ). These data suggest that the relationship between the risk score provided by the IRG signature model and neutrophil infiltration is well-established.…”