Evaluation of Neutrophil–Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence

Document Type : Research Articles


Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Background: Immune system status is a factor related to cervical intraepithelial neoplasia (CIN) recurrence.
neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immune status. The aim of this study was to
evaluate the prognostic value of NLR factor for CIN recurrence in patient who underwent excisional procedure and its
relationship with recurrence free survival (RFS). Methods: In this historical cohort study, a population of 307 patients
with CIN (confirmed by excisional pathology) from 2009 to 2017 were selected. NLR and hematologic factors were
measured before surgery and the follow-up records of these patient were analyzed. The recurrence rate and RFS were
assessed during the follow-up phase. Results: The NLR cut-off point of 1.9 was determined using the Youden Index.
NLRUnivariate analysis showed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) and
platelet lymphocytic ratios (PLR) (P=0.002) were significantly associated with reduction in RFS. The results of Cox
regression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136) significantly reduced
the hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and white blood cell (WBC) count levels (HR
=1.27; 95% CI, 1.04-1.55), significantly decreased RFS, but PLR and ANC associated with RFS were not confirmed
by Cox regression. Conclusion: NLR and total WBC count might be prognostic factors involved in the prediction of
recurrence and RFS in CIN patient underwent excisional procedure. To confirm these results, more prospective studies
with larger sample sizes are needed.


Main Subjects

Volume 20, Issue 8
August 2019
Pages 2365-2372
  • Receive Date: 27 February 2019
  • Revise Date: 12 July 2019
  • Accept Date: 31 July 2019
  • First Publish Date: 01 August 2019