The pretreatment neutrophil-to-lymphocyte ratio predicts therapeutic response to radiation therapy and concurrent chemoradiation therapy in uterine cervical cancer.
BACKGROUND
The aim of this study was to investigate the prognostic role of the pretreatment neutrophil-to-lymphocyte ratio (NLR) as a predictive marker prior to treatment of cervical cancer with radiation therapy (RT) alone or concurrent chemoradiation therapy (CCRT).


METHODS
Fifty-six patients with squamous cell carcinoma (SCC) of the uterine cervix who underwent RT or CCRT from 2005-2013 at the Hirosaki University Hospital were retrospectively identified using electronic databases. Patients were divided into a high NLR group (≥2.5) and a low NLR group (<2.5). The efficacy of RT and CCRT in the two groups was compared.


RESULTS
Of the 56 patients, 35 were in the high NLR group and 21 were in the low NLR group. In comparison to a high NLR, a low NLR was significantly associated with a complete response (P < 0.001). When cancer was divided into stages I/II and III/IV, patients with a low NLR had a significantly better therapeutic outcome than those with a high NLR (P < 0.05). Multivariate analysis showed that only the NLR was a significant prognostic factor for progression-free survival (PFS) and overall survival (OS). Patients with a high NLR had significantly shorter PFS and OS than those with a low NLR.


CONCLUSIONS
Results showed that a low NLR before treatment could predict a good response to RT or CCRT at all stages of uterine cervical cancer. The NLR may be a promising parameter on which to base the choice of a therapeutic strategy to treat SCC of the uterine cervix.
Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Makito
M
Mizunuma
Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. yokoyama@hirosaki-u.ac.jp.
Yoshihito
Y
Yokoyama
Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Masayuki
M
Futagami
Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, 036-8562, Japan.
Masahiko
M
Aoki
Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, 036-8562, Japan.
Yoshihiro
Y
Takai
Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Hideki
H
Mizunuma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000276:immunology / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000532:radiotherapy / Q000628:therapy*
Concurrent chemoradiation therapy; NLR; Radiation therapy; Therapeutic outcome; Uterine cervical cancer