Background/Aim: We evaluated the clinical implications of pre-and post-treatment hematological parameters as prognostic factors in patients with locally advanced cervical cancer (LACC) who received definitive concurrent chemoradiotherapy (CCRT). Patients and Methods: We retrospectively analyzed 125 patients with LACC (FIGO stage IIB to IIIB) who received definitive CCRT. Clinical factors and hematological parameters, including neutrophil-to-lymphocyte ratio (NLR) were assessed pre-and post-CCRT. Univariate and multivariate analysis for diseasefree survival (DFS) and overall survival (OS) were performed using clinicopathological and hematological parameters. Results: Disease recurred in 46 (36.8%) patients, and 24 patients (19.2%) died. On multivariate analysis, posttreatment NLR, ΔNLR (pre-treatment NLR/post-treatment NLR) and ΔPLR (platelet-to-lymphocyte ratio) (pretreatment PLR/post-treatment PLR) were significant prognostic factors for DFS, and only post-treatment NLR was a significant prognostic factor for OS (p<0.001). However, pre-treatment hematological parameters were not associated with prognosis. Conclusion: Post-treatment hematological parameters, particularly NLR, may serve as a prognostic indicator in patients with LACC who received definitive CCRT.Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer-related deaths in women, accounting for 570,000 new cases and over 300,000 deaths worldwide (1). For patients with locally advanced cervical cancer (LACC), definitive concurrent chemoradiotherapy (CCRT) using a cisplatin-based regimen has become the standard treatment. However, about one third of patients with cervical cancer experience recurrence, and recurrence mostly develops within 2 years of therapy completion (2). Therefore, accurate prognosis prediction is important to improve the survival of patients who may benefit from adjuvant treatment or close surveillance. The relationship of inflammation with cancer development and progression is widely accepted, and diverse prognostic markers based on systemic inflammation have been evaluated to predict prognosis in cancer patients (3). In particular, high peripheral neutrophil-to-lymphocyte ratio (NLR) has been recognized as a poor prognostic indicator in various cancers, including cervical cancer (4-12). Recently, post-treatment inflammatory hematological markers and their changes between pre-treatment and post-treatment time points have been reported to be associated with prognosis in 451
Objective: This study evaluated the prognostic value of various lymph node (LN) characteristics, including the lymph node ratio (LNR), in patients with cervical cancer treated with radical hysterectomy. Methods: In this retrospective study, 260 patients with cervical cancer who had undergone radical hysterectomy with pelvic or paraaortic lymphadenectomies were included. LN characteristics related to several LN statuses included total LN counts, LN metastasis, total positive LN counts, LNR, and levels of lymphadenectomy. LNR was defined as the number of metastatic LNs divided by the total number of LNs harvested. Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using the clinicopathological and LN characteristics. Results: Based on receiver-operating characteristics curve analysis, the cut-off value of LNR was 0.0625. Multivariate analysis revealed that high LNR was significantly related to tumor recurrence (hazard ratio [HR], 5.182; 95% confidence interval [CI], 2.424-11.075; p < 0.0001). After adjusting for clinicopathological factors, LNR was also independent prognostic factor for predicting tumor recurrence (HR, 5.930; 95% CI,; p = 0.0007). However, total retrieved LN counts and level of lymphadenectomy were not associated with survival outcomes. Conclusion: LNR may be a prognostic biomarker for predicting disease recurrence in cervical cancer treated with radical hysterectomy.
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