title: Preoperative neutrophil-lymphocyte ratio before platelet-lymphocyte ratio predicts clinical outcome in patients with cervical cancer treated with initial radical surgery.
abstract: OBJECTIVE
  Several inflammatory parameters are applied to predict the survival of patients with various cancers. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are 2 nonspecific markers of systemic inflammation. This study aimed to evaluate the clinicopathologic and prognostic values of NLR and PLR in patients with cervical cancer undergoing primary radical hysterectomy with pelvic lymphadenectomy.
  
  
  METHODS
  A total of 460 cervical cancer patients were enrolled in this study. These patients were histologically confirmed with cervical cancer from February 2005 to June 2008, at the Department of Gynecology, the Third Affiliated Hospital of Harbin Medical University, China. Their clinical and histopathological markers and complete blood counts were collected and analyzed. Prognostic factors were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  The median NLR and PLR were 2.213 and 150.9, respectively. The clinicopathologic analysis showed that NLR was highly associated with depth of stromal infiltration (P = 0.007) and lymph node metastasis (P = 0.003), and PLR was significantly related to tumor size (P = 0.020) and lymph node metastasis (P = 0.027).Univariate analysis identified high NLR as a statistically significant poor predictive factor for the progression-free survival (PFS) (P = 0.008) and overall survival (OS) (P = 0.014), and PLR exhibited no significance on PFS (P = 0.075) and OS (P = 0.110).Multivariable analysis showed that the NLR was an independent prognostic marker for PFS (hazard ratio, 1.799; 95% confidence interval, 1.069-3.028; P = 0.027), but not for OS (hazard ratio, 1.631; 95% confidence interval, 0.968-2.750; P = 0.066).
  
  
  CONCLUSIONS
  Preoperative NLR and PLR were found to be correlated to unfavorable histopathologic features of cervical cancer. The preoperative NLR, but not PLR, may be used as a potential and easy biomarker for survival prognosis in patients with cervical cancer receiving initial radical hysterectomy with pelvic lymphadenectomy.
authors.affiliation: *Department of Gynecology, The Third Affiliated Hospital, and †Department of Neurology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Le
authors.initials: L
authors.lastname: Wang
authors.forename: Yunduo
authors.initials: Y
authors.lastname: Liu
authors.forename: Shuxiang
authors.initials: S
authors.lastname: Wang
authors.forename: Pan
authors.initials: P
authors.lastname: Shang
authors.forename: Ya
authors.initials: Y
authors.lastname: Gao
authors.forename: Xiuwei
authors.initials: X
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D001792:Blood Platelets / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008214:Lymphocytes / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009504:Neutrophils / Q000473:pathology*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms; D055815:Young Adult