The Platelet-to-Lymphocyte Ratio (PLR) as a Non-Invasive Biomarker for Cervical Malignancy in Conization Patients

Abstract

Background: Cervical cancer continues to pose a significant global health challenge, particularly in low-resource regions with limited access to advanced diagnostics. Cervical conization can occasionally uncover invasive carcinoma in patients initially suspected of having only pre-invasive lesions. This study assessed the platelet-to-lymphocyte ratio (PLR) as a potential predictive biomarker for identifying invasive disease in patients undergoing a loop electrosurgical excision procedure (LEEP).

Methods: A retrospective study was conducted on 371 patients who underwent LEEP conization for cervical dysplasia. Preoperative PLR values were collected and compared across final histopathological categories (negative, low-grade, high-grade, invasive carcinoma) using the Kruskal-Wallis test, followed by Mann-Whitney U tests for pairwise comparisons. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic accuracy.

Results: PLR values above 7.7 were significantly associated with HPV positivity, increasing with histopathological severity. There were significant PLR differences across the outcome groups (p = 0.005), with notably higher values in cases of invasive carcinoma (p < 0.01). ROC analysis showed moderate diagnostic utility (AUC ≈ 0.72); at a PLR cutoff of ~11.9, sensitivity was 65% and specificity 81%.

Conclusions: The PLR cutoff of 7.7 was associated with HPV positivity, while a higher cutoff of 11.93 was identified for predicting invasive cervical cancer. These findings support that preoperative PLR is a non-invasive, clinically relevant marker correlated with lesion severity, offering potential for preoperative risk stratification, particularly where advanced diagnostics are limited.

Keywords: HPV DNA; ROC analysis; biomarkers; cervical cancer; invasive carcinoma; platelet-to-lymphocyte ratio (PLR); risk stratification; systemic inflammation.

Figure 1

Flowchart of patient selection for the SCOPE Study.

Figure 2

Boxplot of PLR values by HPV DNA status. Boxplot compares the distribution of PLR values between HPV DNA-negative and HPV DNA-positive patients. The median PLR was higher in HPV-positive individuals, with a wider range of values. Asterisks (*) denote a statistically significant difference between the two groups (p < 0.05).

Figure 3

Boxplot of PLR values across histological grades. This figure illustrates the distribution of PLR values across four histopathological conization grades: Grade I (negative), Grade II (low-grade lesions), Grade III (high-grade lesions), and Grade IV (invasive carcinoma). The plot reveals a progressive increase in PLR with advancing disease severity, with Grade IV showing significantly higher PLR values compared to Grades I, II, and III. Asterisks (*) denote statistically significant differences between the groups.

Figure 4

Distribution of histological grades within quartile-based PLR groups. This stacked bar chart shows the percentage of conization outcomes (Grades I–IV) within four quartile ranges (Q1: 3.3–6.9; Q2: 7.0–8.9; Q3: 8.9–11.3; Q4: 11.3–184.2) of the platelet-to-lymphocyte ratio (PLR). As PLR values increase, the proportion of patients with invasive carcinoma (Grade IV, red) also increases, whereas the proportion of benign (Grade I, green) or low-grade lesions (Grade II, light green) decreases.

Figure 5

Receiver operating characteristic (ROC) curve for PLR in predicting cervical cancer. ROC curve compares the diagnostic performance of the platelet-to-lymphocyte ratio for identifying cervical cancer. Sensitivity (true-positive rate) is plotted on the y-axis, while 1-specificity (false-positive rate) is on the x-axis.