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. 2019 Aug 1;20(8):2365-2372.
doi: 10.31557/APJCP.2019.20.8.2365.

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

Farah Farzaneh  1 , Nafiseh Faghih  1 , Maryam Sadat Hosseini  1 , Maliheh Arab  1 , Tahereh Ashrafganjoei  1 , Atyeh Bahman  1
Affiliations

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

Farah Farzaneh et al. Asian Pac J Cancer Prev. .

Abstract

Background: Immune system status is a factor related to cervical intraepithelial neoplasia (CIN) recurrence. neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immune status. The aim of this study was to evaluate the prognostic value of NLR factor for CIN recurrence in patient who underwent excisional procedure and its relationship with recurrence free survival (RFS). Methods: In this historical cohort study, a population of 307 patients with CIN (confirmed by excisional pathology) from 2009 to 2017 were selected. NLR and hematologic factors were measured before surgery and the follow-up records of these patient were analyzed. The recurrence rate and RFS were assessed during the follow-up phase. Results: The NLR cut-off point of 1.9 was determined using the Youden Index. NLR<1.9 (low NLR) and NLR≥1.9 (high NLR) were observed among 68.1% and 39.1% of patients, respectively. Univariate analysis showed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) and platelet lymphocytic ratios (PLR) (P=0.002) were significantly associated with reduction in RFS. The results of Cox regression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136) significantly reduced the hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and white blood cell (WBC) count levels (HR =1.27; 95% CI, 1.04-1.55), significantly decreased RFS, but PLR and ANC associated with RFS were not confirmed by Cox regression. Conclusion: NLR and total WBC count might be prognostic factors involved in the prediction of recurrence and RFS in CIN patient underwent excisional procedure. To confirm these results, more prospective studies with larger sample sizes are needed.

Keywords: Blood Platelets; Lymphocytes; Neutrophils; Recurrence; cervical intraepithelial neoplasia.

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Figures

Figure 1
Figure 1
Diagram of Participant Recruitment
Figure 2
Figure 2
Receiver Operating Characteristics (ROC) Curve of NLR for Predicting Recurrence. NLR, Neutrophil-Lymphocyte Ratio
Figure 3
Figure 3
Recurrence Rate According to the NLR Level.NLR, Neutrophil-Lymphocyte Ratio
Figure 4
Figure 4
Kaplan-Mire Plot of RFS According to the NLR Level
See this image and copyright information in PMC

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