Pretreatment neutrophil to lymphocyte and platelet to lymphocyte ratios as predictive factors for the survival of cervical adenocarcinoma patients
Received 1 July 2018
Accepted for publication 1 September 2018
Published 22 November 2018 Volume 2018:10 Pages 6029—6038
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Joanna Jonska-Gmyrek,1 Leszek Gmyrek,2 Agnieszka Zolciak-Siwinska,3 Maria Kowalska,4 Malgorzata Fuksiewicz,4 Beata Kotowicz4
1Department of Uro-oncology, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland; 2Department of Gynecological Oncology, The Holy Family Hospital, Warsaw 02-544, Poland; 3Department of Brachytherapy, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland; 4Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland
Objective: Our study assessed the clinical utility and prognostic value of pretreatment hematological parameters and calculated coefficients including the platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR) in patients with cervical adenocarcinoma (CA).
Materials and methods: Among 738 cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IA–IV treated at our institution, 96 (13%) presented with CA histology. The blood samples, collected within 10 days before treatment, were analyzed using a Sysmex XN-2000 system. The statistical tests included Mann–Whitney U-tests, log-rank tests, and Cox regression models. The cutoff points for the calculated hematological coefficients (NLR, PLR, and MLR) were determined using the MedCalc statistical program.
Results: The prognostic factor for overall survival (OS) and recurrence-free survival (RFS) in CA was clinical stage according to FIGO classification (FIGO IIB–IV vs I–IIA) (P=0.0001; P=0.002). Among patients with FIGO stage IIB–IV treated with radiotherapy/chemoradiotherapy, an elevated PLR was a negative prognostic factor for OS (P=0.017; HR: 2.96; 95% CI: 2.069–3.853). Among all patients, an elevated pretreatment NLR was a poor prognostic factor for OS (P=0.014; HR: 2.85; 95% CI: 2.011–3.685) and RFS (P=0.049; HR: 4.0; 95% CI: 2.612–5.392). The white blood cell count (WBC) before treatment was significantly higher in patients who died during follow-up (P=0.009).
Conclusion: Elevated NLR values before treatment may be associated with a shorter time of RFS and OS, while PLR index may have prognostic significance for OS in patients with advanced disease (FIGO IIB–IV). Both indexes and WBC may be a cost-effective biomarker that can be used conveniently for stratification of recurrence risk and death.
Keywords: platelet to lymphocyte ratio, cervical cancer, neutrophil to lymphocyte ratio, prognostic factors
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