Document Type : Research Articles
Master Program in Biomedicine, Faculty of Medicine, Udayana University, Bali, Indonesia.
Department of Clinical Pathology, Sanglah General Hospital, Udayana University, Faculty of Medicine, Bali, Indonesia.
Post Graduate Student, Faculty of Medicine, Udayana University, Bali, Indonesia.
Post Graduate Student, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
Public Health Officer, Timor Tengah Utara Health Department, East Nusa Tenggara Province, Indonesia.
Post graduate student in public health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
Department of Obstetrics and Gynecology, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia.
International Program of Medicine, Taipei Medical University, Taipei, Taiwan.
Medical and Health Education, Faculty of Medicine, Udayana University, Bali, Indonesia.
Background: Inflammation represents a pivotal role in the progression of cervical cancer. The hematological
markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of
the disease. Objective: The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio
(NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer. Methods:
A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General
Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were
collected and analyzed using SPSS ver. 16 software. FIGO stage I–II and III-IV were classified as early and advance
stage respectively. Results: The median NLR and PLR were significantly higher in the advance stage compared with
early stage (7.58 (1.36-33.20) and 247.89 (97.10-707.11); p-value = 0.001). A strong positive correlation was found
between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity
value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found
in high NLR (adjusted OR: 9.02; 95%CI=2.42-33.64; p=0.001) and PLR (adjusted OR = 2.47; 95% CI = 1.45-4.85;
p = 0.032). Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting
the staging of cervical cancer.