The Neutrophil-Lymphocyte Ratio Predicts Recurrence of Cervical Intraepithelial Neoplasia

Abstract

OBJECTIVE: The purpose of the present study was to determine the prognostic significance of the neutrophil-lymphocyte ratio (NLR) in recurrence of cervical intraepithelial neoplasia (CIN).METHODS: We evaluated the NLR as a prognostic marker in the entire cohort of 230 patients who had undergone surgical resection and were diagnosed with CIN. Subjects were categorized into two different groups based on the NLR (NLR-high and NLR-low) using cutoff values determined by receiver operating characteristic (ROC) analysis. The primary research objective for this study was to validate the impact of the NLR on recurrence-free survival (RFS) in patients with CIN. The secondary objective was to evaluate the impact of other hematologic parameters on RFS in CIN patients.RESULTS: Using the entire cohort, the most appropriate NLR cut-off value for CIN recurrence selected on the ROC curve was 2.1. The NLR-low and NLR-high groups included 167 (72.6%) and 63 patients (27.4%), respectively. According to Kaplan-Meier analysis, RFS rates during the entire follow-up period were considerably lower in the NLR-high group than in the NLR-low group (P = 0.0125). In multivariate survival analysis using Cox proportional hazard model, we identified the NLR, absolute eosinophil count (AEC), hemoglobin concentration, and mean corpuscular volume (MCV) as valuable prognostic factors that impact RFS.CONCLUSIONS: The NLR is an independent prognosticator for RFS following surgical resection in CIN patients. We also found that the AEC, hemoglobin level, and MCV were strongly associated with RFS, as determined by multivariate analysis using a Cox model. These hematological parameters might provide additional prognostic value beyond that offered by standard clinicopathologic parameters.

Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

“…Nakamura et al found that the progression free and overall survival hazard ratio of 0.317 (95% confidence interval (CI): 0.167 0.602; P<0.001) and 0.274 (95% CI:0.141-0.530; P<0.001), respectively (Nakamura et al, 2018). Chun S. et al found a similar finding with the recurrence free survival hazard ratio of cervical intraepithelial neoplasia for 7.66(95% CI 2.34-25.1, p=0.001) (Chun et al, 2017). Moreover, the NLR can provide a valid prediction on the prognosis of the patient with stage IIB and the metastasis of the lymph nodes.…”

“…Lee et al, (2012) have suggested the use of NLR for estimating the mortality and the recurrences of cervical cancer. A high NLR is correlated with the poor prognosis of cervical carcinoma patients (Nakamura et al, 2018;Chun et al, 2017;Nakamura et al, 2015). The pretreatment NLR level is inversely correlated with the survival time in the cervical carcinoma patients (R=-0.538, R2=-0.289, P=0.002).…”

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

“…In the current study, NLR and total WBC count were known to be prognostic factors for predicting the likelihood of recurrence in patients who underwent excisional procedure for CIN. Chun et al, (2017) investigated the relationship between NLR and recurrence of CIN in Korea. They studied 230 patients who underwent excisional procedure for CIN.…”

“…The sample size was calculated to detect the hazard ratio of 3.54 for the risk of recurrence of NLR 2.1 (Chun et al, 2017) with power of 80%, alpha of 0.05, and attrition rate of 10 percent. The required sample size was calculated to be at least 301 patients.…”

“…NLR has been used as a prognostic factor in various types of cancers and also for examining the immune system (Guthrie et al, 2013). In a study on the relationship between NLR and CIN in South Korea, it was found that individuals with a high NLR level had a high risk of recurrence (Chun et al, 2017).…”