Abstract
There are few studies between postoperative neutrophil to lymphocyte ratio (NLR) and survival in cervical cancer. We compared postoperative changes in NLR according to surgical methods and analyzed the effect of these changes on 5-year mortality of cervical cancer patients. A total of 929 patients were assigned to either the laparoscopic radical hysterectomy (LRH) (n = 721) or open radical hysterectomy (ORH) (n = 208) group. Propensity score matching analysis compared the postoperative NLR changes between the two groups, and multivariate logistic regression analysis evaluated the association between NLR changes and 5-year mortality. Surgical outcomes between the two groups were also compared. In the LRH group, NLR changes at postoperative day (POD) 0 and POD 1 were significantly lower than in the ORH group after matching (NLR change at POD 0, 10.4 vs. 14.3, p < 0.001; NLR change at POD 1, 3.5 vs. 5.4, p < 0.001). In multivariate logistic regression analysis, postoperative NLR change was not associated with 5-year mortality (2nd quartile: OR 1.55, 95% CI 0.56–4.29, p = 0.401; 3rd quartile: OR 0.90, 95% CI 0.29–2.82, p = 0.869; 4th quartile: OR 1.40, 95% CI 0.48–3.61, p = 0.598), whereas preoperative NLR was associated with 5-year mortality (OR 1.23, 95% CI 1.06–1.43, p = 0.005). After matching, there were no significant differences in surgical outcomes between the two groups. There were significantly fewer postoperative changes of NLR in the LRH group. However, the extent of these NLR changes was not associated with 5-year mortality. By contrast, preoperative NLR was associated with 5-year mortality.
Highlights
Cervical cancer, predominantly caused by the human papillomavirus (HPV), is one of the most common gynecological cancers [1]
0.48–3.61, p = 0.598), whereas preoperative neutrophil to lymphocyte ratio (NLR) was associated with 5-year mortality
There have been several reports stating that immune function and inflammatory response in cervical cancer patients is associated with recurrence and survival rate [7,8]
Summary
Predominantly caused by the human papillomavirus (HPV), is one of the most common gynecological cancers [1]. Cervical cancer has a high recurrence rate even after surgery. According to a related study, postoperative recurrence rates of stage I B–II A stage and II B–IV A stage were 10%–20%. There have been several reports stating that immune function and inflammatory response in cervical cancer patients is associated with recurrence and survival rate [7,8]. Among many inflammatory biomarkers, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were reported as predictors of cancer staging, recurrence, and survival outcomes in cervical cancer [9,10,11]. Postoperative NLR has been reported to predict survival and complications in some cancers [18,19,20]. There are few studies between postoperative NLR changes by surgical methods
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