title: Pretreatment leukocytosis is an indicator of poor prognosis in patients with cervical cancer.
abstract: OBJECTIVE
  The aim of this study was to investigate the prognostic value of pretreatment leukocytosis in patients with cervical cancer in relation to well-established conventional risk factors.
  
  
  METHODS
  The baseline characteristics and outcome data from 536 patients treated for cervical cancer between 1996 April to 2007 March were collected and reviewed. Cox proportional hazards regression model was used to identify independent prognostic factors for overall survival. Subsequently, the prognostic significance of pretreatment WBC count was prospectively investigated in 156 patients newly diagnosed cervical cancer from 2007 April to 2010 March.
  
  
  RESULTS
  In a retrospective analysis, patients with leukocytosis (WBC ≥ 10,000/μl) showed significantly higher treatment failure rate (P < 0.0001) and shorter OS (P < 0.0001) than the patients without leukocytosis. Tumors from patients with leukocytosis showed significantly stronger immunoreactivity for G-CSF than those obtained from patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, histology, and elevated WBC count (≥ 10,000/μl) were significant prognostic factors in terms of overall survival. In a prospective investigation, patients with leukocytosis showed significantly higher treatment failure rate (P < 0.0001), shorter PFS (P < 0.0001), and higher serum G-CSF concentrations (p = 0.001) than the patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, and elevated WBC count were significant prognostic factors in terms of PFS.
  
  
  CONCLUSIONS
  Pretreatment leukocytosis is an independent prognostic factor in patients with cervical cancer. Our finding can be used to identify patients with poor prognosis and to design future tailored clinical trials.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. smabuchi@gyne.med.osaka-u.ac.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Mabuchi
authors.forename: Yuri
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Isohashi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yoshioka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohashi
authors.forename: Eiichi
authors.initials: E
authors.lastname: Morii
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Aozasa
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000096:biosynthesis / Q000097:blood; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000473:pathology
chemical_list: D016179:Granulocyte Colony-Stimulating Factor