title: Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva?
abstract: OBJECTIVE
  To determine whether the neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) before complete surgical staging provide information on lymph node metastasis in vulvar squamous cell carcinoma (SCC).
  
  
  METHODS
  All patients with vulvar SCC who underwent complete surgical staging at two institutions between 1 January 2005 and 31 December 2011 were identified retrospectively from patient databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate cut-off, sensitivity, and specificity values for preoperative NLR and PLR to predict lymph node metastasis.
  
  
  RESULTS
  Data from 64 women with adequate information were analyzed. Lymph node involvement was detected in 19 (29.7%) patients. NLR and PLR were higher in the lymph node--positive group than in the--negative group (p < 0.001). The best cut-off values for predicting lymph node metastasis were 2.81 for the NLR, with 84.5% sensitivity and 89.5% specificity, and 139.5 for the PLR, with 68.9% sensitivity and 89.5% specificity. Forty of the 64 (62.5%) patients had NLRs ≤ 2.81 and 24 (37.5%) had NLRs >2.81. Lymph node involvement was more common in the NLR >2.81 group [60.7% vs. 5.6%; relative risk RR = 10.9, 95% confidence interval CI = 2.7-43.4; p < 0.001]. Mean tumor sizes were 4.2 ± 2.3 cm in the NLR >2.81 group and 2.1 ± 1.2 cm in the NLR ≤ 2.81 group (p = 0.001). The rate of lymph node involvement was higher in the PLR >139.5 group than in the PLR ≤ 139.5 group (54.8% vs. 6.1%; RR = 9.0, 95% CI = 2.2-35.9; p<0.001).
  
  
  CONCLUSIONS
  Preoperative NLR and PLR are directly associated with nodal involvement status of vulvar SCC. These markers are simple, readily obtained and calculated, and easy to integrate into the surgical work-up of patients with vulvar SCC, at no extra cost.
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey. Electronic address: drertas@gmail.com.
authors.forename: Ibrahim Egemen
authors.initials: IE
authors.lastname: Ertas
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.forename: Levent
authors.initials: L
authors.lastname: Akman
authors.forename: Aykut
authors.initials: A
authors.lastname: Ozdemir
authors.forename: Mustafa Cosan
authors.initials: MC
authors.lastname: Terek
authors.forename: Aydin
authors.initials: A
authors.lastname: Ozsaran
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Sanci
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Dikmen
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D018655:Lymphocyte Count; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D014844:Vulva; D014846:Vulvar Neoplasms / Q000473:pathology*
keywords: Lymph node metastasis; Neutrophil:lymphocyte ratio; Platelet:lymphocyte ratio; Preoperative; Vulvar squamous cell carcinoma