Prognostic significance of neutrophil lymphocyte ratio in patients of carcinoma cervix treated with radiotherapy

Abstract

Background: The elevated neutrophil-to-lymphocyte ratio (NLR) has been identified as a poor prognostic indicator in various malignancies. The progression of malignancies is manifested as alteration in blood counts which can be used as the prognostic markers. Aim: The aim of the present study is to analyze the effect of pretreatment NLR and other hematological variables on progression-free survival (PFS) and overall survival (OS) among cervical cancers patients. Materials and Methods: The present retrospective study enrolled 303 cervical cancer (Stage IIB–IVA) patients treated by radical radiotherapy from January 2016 to December 2018. The pretreatment values of NLR, absolute neutrophil count, and absolute lymphocyte count (ALC) were recorded for each patient and their associations with the clinicopathologic variables, PFS, and OS were analyzed. Results: The optimal cutoff value of NLR was 3.0. The median follow-up period was 19 months. On univariate analysis, PFS rates during the follow-up period were significantly lower in NLR-high versus NLR-low group (P = 0.042) and in low-ALC versus high-ALC group (P = 0.018). Multivariate Cox-proportional hazards model identified NLR and ALC as the strongest prognostic factors for PFS. On univariate analysis, OS was better for patients with the International Federation of Gynecology and Obstetrics Stage IIB versus III–IVA (P = 0.046) and ALC >2000/c.mm versus ≤2000/c.mm (P = 0.050), respectively. None of the hematological variables remained significant for OS on the multivariate analysis. Conclusion: High-NLR is associated with worse survival outcomes in cervical cancer patients. NLR and ALC are the independent prognostic factors for PFS in cervical cancer patients.