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

Jeong Won Lee,Ki Ho Seol

doi:10.3390/jcm10102199

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.

Highlights

The preferred treatment for patients with locally advanced cervical cancer is definitive radiotherapy with concurrent cisplatin-based chemotherapy [1]
After completion of concurrent chemoradiotherapy (CCRT), radiologically complete remission was attained in 145 patients and radiologically partial remission was attained in 3 patients
This study revealed that the overall survival (OS) and disease-free survival (DFS) rate were significantly lower in the high neutrophil-to-lymphocyte ratio (NLR)-platelet-to-lymphocyte ratio (PLR) group compared with the OS and DFS rate in the low NLR-PLR group (p = 0.001 for OS, p = 0.026 for DFS; Figures 1 and 2)

Summary

Introduction

The preferred treatment for patients with locally advanced cervical cancer is definitive radiotherapy with concurrent cisplatin-based chemotherapy [1]. Definitive concurrent chemoradiotherapy (CCRT) with cisplatin improves the survival of cervical cancer patients, approximately one-third suffer from tumor recurrence or progression [2,3]. The patients with recurrent and metastatic cervical cancer have limited systemic treatment options including combination chemotherapy with the addition of the anti-vascular endothelial growth factor monoclonal antibody, and the prognosis is poor [4,5]. The association of diverse hematologic parameters of systemic inflammation with cancer prognosis has been investigated [8,10]. Investigations into hematologic parameters for cervical cancer have mainly focused on NLR and its prognostic value [11].

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Conclusion