Pretreatment Neutrophil-to-Lymphocyte Ratio Combined with Platelet-to-Lymphocyte Ratio as a Predictor of Survival Outcomes after Definitive Concurrent Chemoradiotherapy for Cervical Cancer

Abstract

The aim of the study was to evaluate pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for predicting clinical outcomes after definitive concurrent chemoradiotherapy (CCRT) for cervical cancer. The cases were divided into two groups based on the values of NLR and PLR: High NLR-PLR (high value in both NLR and PLR) and Low NLR-PLR (low value in either NLR or PLR). The relationships between survival outcomes and the pretreatment NLR-PLR were investigated. Of the 148 patients enrolled in the study, 30 patients died during the median follow-up of 75 months. Based on receiver operating curves, NLR and PLR cut-off values for survival analysis were 2.34 and 148.89. The 10-year overall survival and disease-free survival rates for high NLR-PLR vs. low NLR-PLR were 63.6% vs. 86.2% (p = 0.001) and 63.3% vs. 77.5% (p = 0.026), respectively. Based on a multivariate analysis, independent predictors of overall survival were high NLR-PLR (hazard ratio [HR], 2.435; 95% confidence interval [CI], 1.106–5.361; p = 0.027) and stage (HR 2.659; 95% CI, 1.146–6.613; p = 0.024). Increases in both NLR and PLR are associated with poor survival. Elevation in both NLR and PLR before initiation of CCRT may be a useful biomarker for predicting clinical outcomes.

Pretreatment Neutrophil-to-Lymphocyte Ratio and Lactate Dehydrogenase Predict the Prognosis of Metastatic Cervical Cancer Treated with Combination Immunotherapy

“…Lima et al reported an adverse association between NLR and prognosis in cervical cancer [ 36 ], whereas Zhang et al showed the correlation of preoperative NLR with unfavorable histopathological features and prognosis in patients with cervical cancer who underwent surgery [ 24 ]. Additionally, pretreatment NLR could be a prognostic factor after chemotherapy and radiotherapy for cervical cancer [ 19 , 22 , 37 ]. More recently, the adverse association between NLR and prognosis in patients treated with immunotherapy has been reported.…”

Pretreatment Systemic Inflammatory Markers, Neutrophil Lymphocyte Ratio, and Platelet Lymphocyte Ratio as a Prognostic Factor in Cervical Cancer: A Retrospective Study

“…21 In some studies PLR correlated with survival outcomes 19,22 while some found NLR to have correlation with survival outcomes, 15,20,23 whereas some found both NLR and PLR to correlate with poorer survival outcomes. 16,24,25 In this study, ROC curve analysis of local recurrence yielded the NLR cutoff value as 2.45 (AUC ¼ 0.839) with a sensitivity of 82.6% and specificity of 77.7% and the PLR cutoff value 140.6 (AUC ¼ 0.892) with a sensitivity of 85.5% and specificity of 80.6%. This matched with another study, the sensitivity value for NLR was 82% and specificity 71% with a cutoff of 3.38 using ROC analyses and 72 and 70% with cutoff of 172.05 for PLR, respectively, for predicting stage with NLR and PLR.…”

“…21 In some studies PLR correlated with survival outcomes 19 22 while some found NLR to have correlation with survival outcomes, 15 20 23 whereas some found both NLR and PLR to correlate with poorer survival outcomes. 16 24 25…”

Systemic inflammation factors as survival prognosis markers in ovarian neoplasm and the relationship with cancer-associated inflammatory mediators—a review

“…This constitutes the scientific foundation, which allows the practitioner to evaluate, indirectly, the dimensions of inflammation in cancer, and these parameters NLR, PLR, and LMR are potential clinical prognostic markers. NLR has been repeatedly reported as a prognostic factor in ovarian cancer patients in advanced stages of the disease, 11,[66][67][68][69] in patients with other tumor locations 70,71 or may be useful in selecting patients for different types of immunotherapy. 66,72 Mechanisms of antineoplastic defense by activating innate immune cells.…”