Predictive value of preoperative lymphocyte-to-monocyte ratio on pelvic lymph node metastasis of early cervical cancer patients

Abstract

Objective To explore the value of lymphocyte-to-monocyte ratio (LMR) on pelvic lymph node metastasis (PLNM) of early cervical cancer patients. Methods The clinical and pathological data of 516 patients with early cervical cancer whose initial treatment were radical hysterectomy in the Affiliated Nanchong Central Hospital of North Sichuan Medical College from January 2008 to January 2018 were selected into this study. According to being accompanied with PLNM or not, they were divided into PLNM (+ ) group (n=113) and PLNM(-)group (n=403). Retrospective analysis was used to analyze clinical data of all subjects. Chi-square was used to statistically compare the proportions of the age, International Federation of Gynecology and Obstetrics (FIGO) clinical stages, histopathological grades, histopathological types, vessel carcinoma embolus, parametrial invasion, cervical interstitial invasion depth, tumor diameters, levels of serum squamous cell carcinoma antigen(SCC-Ag), LMR between two groups. The receiver operating characteristic (ROC) curve of LMR predicting PLNM in early cervical cancer patients was drawn and analyzed, and the area under ROC curve (ROC-AUC) was calculated. The accuracy of LMR in the prediction of PLNM in early cervical cancer patients was evaluated by multivariate unconditional logistic regression analysis. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. There was no significant difference between two groups in age (P>0.05). Results ①The results of univariate analysis showed that there were significant differences in proportions of FIGO clinical stages, histopathological grades, histopathological types, tumor diameters, levels of serum SCC-Ag, vessel carcinoma embolus, parametrial invasion, depth of cervical interstitial invasion and LMR (χ2=13.057, 18.998, 9.584, 85.667, 7.225, 88.538, 69.807, 32.644, 126.453; P 2.2 (OR=0.155, 95%CI: 0.081-0.296, P<0.001) was the protective factor of PLNM in early cervical cancer patients. ③The ROC curve of LMR predicting PLNM of early cervical cancer showed that the ROC-AUC was 0.790 (95%CI: 0.753-0.825, P<0.001). According to the maximum principle of the Youden index, the optimal cut-off value of LMR predicting PLNM in patients with early cervical cancer was 2.2, and the sensitivity and specificity were 66.4% and 85.9%, respectively. Conclusion Peripheral blood LMR>2.2 is an independent protective factor to predict PLNM of early cervical cancer. Key words: Uterine cervical neoplasms; Neoplasms, squamous cell; Lymphocyte-to-monocyte ratio; Lymphatic metastasis; Lymphocytes, tumor-infiltrating; ROC curve; Women