Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP

Abstract

Purpose: The platelet-to-lymphocyte ratio (PLR) is considered correlated with cancer prognosis including cervical cancer, in addition to high-risk papillomavirus (HR-HPV) infection, of which the predictive value in prognosis of high-grade squamous intraepithelial lesions (HSILs) remains unknown. Here, the prognostic predictive value of PLR in HSIL after loop electrosurgical excision procedure (LEEP) was evaluated.

Patients and methods: This study included 335 nonpregnant participants with histopathologically confirmed HSIL and 3- and 5-year follow-ups from the Fujian Cervical Lesions Screening Cohorts (FCLSCs) between September 2016 and September 2018. PLR and other variables were evaluated to identify the factors related to the recurrence/residual cervical intraepithelial neoplasia (CIN)-free survival (RFS), namely, the time from LEEP at baseline to first detection of recurrence/residual CIN or end of follow-up, by logistic and Cox regression.

Results: In the Kaplan‒Meier analysis, HR-HPV infection (p=0.049/0.012), higher PLR (p=0.031/0.038), and gland invasion (p=0.047) had a higher risk for recurrence/residual CIN at the 3-/5-year follow-up. The univariate logistic and Cox regression analyses showed significant differences and a higher cumulative risk in patients with HR-HPV infection (OR=3.917, p=0.026; HR=3.996, p=0.020) and higher PLR (OR=2.295, p=0.041; HR=2.161, p=0.030) at the 5-year follow-up. The findings by multivariate Cox regression analysis were similar, indicating a poor prognosis for patients with HR-HPV infection (HR=3.901, p=0.023) and higher PLR (HR=2.082, p=0.038) at the 5-year follow-up. The calibration plot showed a better model fit for RFS at the 3-year follow-up.

Conclusion: Preoperative PLR level and HR-HPV infection could be available markers for predicting recurrence/residual disease of HSIL after LEEP. Clinically, combining PLR with HR-HPV tests may provide novel evaluation method and reference for management in post-treatment patients with cervical precancerous lesions.

Keywords: HPV; cervical intraepithelial neoplasia; conization; human papillomavirus; prognosis; systemic inflammatory response.

Figure 1

Kaplan‒Meier curves for variables in relation to recurrence/residual CIN. (A) Some serum markers analysed by ROC curve analysis; (B) Preoperative HR-HPV infection promotes recurrence/residual CIN at the 3-year follow-up; (C) Preoperative high PLR level promotes recurrence/residual CIN at the 3-year follow-up; (D) Preoperative HR-HPV infection promotes recurrence/residual CIN at the 5-year follow-up; (E) Preoperative high PLR level promotes recurrence/residual CIN at the 5-year follow-up; (F) Gland invasive status promotes recurrence/residual CIN at the 5-year follow-up.

Figure 2

Flow chart of the study.

Figure 3

The Cox regression analysis during the follow-up. (A) The forest plot of HR for recurrence/residual disease at the 3-year follow-up (univariate analysis); (B) The forest plot of HR for recurrence/residual disease at the 5-year follow-up (univariate analysis); (C) Forest plot of HR for recurrence/residual disease at the 5-year follow-up (multivariate analysis). A p value<0.05 indicates a statistically significance.

Figure 4

Established models for predicting the prognosis in patients. (A) Nomogram for predicting recurrence/residual disease by Cox regression; (B) Calibration plot at the 3-year follow-up; (C) Calibration plot at the 5-year follow-up; (D) Higher PLR & HR-HPV (P-H) score led to worse prognosis at the 5-year follow-up.