Abstract
Background:Inflammation represents a pivotal role in the progression of cervical cancer. The hematological markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of the disease.Objective:The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer.Methods:A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were collected and analyzed using SPSS ver. 16 software. FIGO stage I–II and III-IV were classified as early and advance stage respectively.Results:The median NLR and PLR were significantly higher in the advance stage compared with early stage (7.58 (1.36-33.20) and 247.89 (97.10-707.11); p-value = 0.001). A strong positive correlation was found between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found in high NLR (adjusted OR: 9.02; 95%CI=2.42-33.64; p=0.001) and PLR (adjusted OR = 2.47; 95% CI = 1.45-4.85; p = 0.032).Conclusion:Increased pretreatment NLR and PLR values may provide a useful information in predicting the staging of cervical cancer.
Highlights
Cervical cancer (CC) is known as the second most common gynecological malignancy of women worldwide whereas 250,000 patients approximately die from this disease annually (Jemal et al, 2011)
The systemic inflammation can be manifested as neutrophilia, thrombocytosis and relative lymphocytopenia detected in a complete blood count (CBC) examination (Grivennikov et al, 2010)
Laboratory parameters such as white blood cells (WBC), lymphocytes, neutrophils, platelet, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Basophil-to-lymphocyte ratio (BLR), and Monocyte Lymphocyte Ratio (MLR) were significantly higher in the advance stage cancer group compared to the early stage group (p
Summary
Cervical cancer (CC) is known as the second most common gynecological malignancy of women worldwide whereas 250,000 patients approximately die from this disease annually (Jemal et al, 2011). Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and Glasgow Prognostic Score (GPS) are established as predictive values for numerous malignant tumors (Hefler et al, 2008; McMillan, 2013; Tas and Erturk, 2017). These markers were non-specific and may not always be available in secondary health services. The hematological markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of the disease. Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting the staging of cervical cancer
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