Evaluation of Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence

Abstract

Background: Immune system status is a factor related to cervical intraepithelial neoplasia (CIN) recurrence.<br />neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immune status. The aim of this study was to<br />evaluate the prognostic value of NLR factor for CIN recurrence in patient who underwent excisional procedure and its<br />relationship with recurrence free survival (RFS). Methods: In this historical cohort study, a population of 307 patients<br />with CIN (confirmed by excisional pathology) from 2009 to 2017 were selected. NLR and hematologic factors were<br />measured before surgery and the follow-up records of these patient were analyzed. The recurrence rate and RFS were<br />assessed during the follow-up phase. Results: The NLR cut-off point of 1.9 was determined using the Youden Index.<br />NLRUnivariate analysis showed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) and<br />platelet lymphocytic ratios (PLR) (P=0.002) were significantly associated with reduction in RFS. The results of Cox<br />regression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136) significantly reduced<br />the hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and white blood cell (WBC) count levels (HR<br />=1.27; 95% CI, 1.04-1.55), significantly decreased RFS, but PLR and ANC associated with RFS were not confirmed<br />by Cox regression. Conclusion: NLR and total WBC count might be prognostic factors involved in the prediction of<br />recurrence and RFS in CIN patient underwent excisional procedure. To confirm these results, more prospective studies<br />with larger sample sizes are needed.