Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

Document Type : Research Articles


1 Master Program in Biomedicine, Faculty of Medicine, Udayana University, Bali, Indonesia.

2 Department of Clinical Pathology, Sanglah General Hospital, Udayana University, Faculty of Medicine, Bali, Indonesia.

3 Post Graduate Student, Faculty of Medicine, Udayana University, Bali, Indonesia.

4 Post Graduate Student, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.

5 Public Health Officer, Timor Tengah Utara Health Department, East Nusa Tenggara Province, Indonesia.

6 Post graduate student in public health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.

7 Department of Obstetrics and Gynecology, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia.

8 International Program of Medicine, Taipei Medical University, Taipei, Taiwan.

9 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.


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