Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

Abstract

Background: Inflammation represents a pivotal role in the progression of cervical cancer. The hematological<br />markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of<br />the disease. Objective: The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio<br />(NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer. Methods:<br />A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General<br />Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were<br />collected and analyzed using SPSS ver. 16 software. FIGO stage I–II and III-IV were classified as early and advance<br />stage respectively. Results: The median NLR and PLR were significantly higher in the advance stage compared with<br />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<br />between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity<br />value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found<br />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;<br />p = 0.032). Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting<br />the staging of cervical cancer.