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Preoperative Neutrophil-Lymphocyte Ratio Before Platelet-Lymphocyte Ratio Predicts Clinical Outcome in Patients With Cervical Cancer Treated With Initial Radical Surgery
  1. Yu Zhang, MD*,
  2. Le Wang, MD,
  3. Yunduo Liu, PhD*,
  4. Shuxiang Wang, MD*,
  5. Pan Shang, MD*,
  6. Ya Gao, MD* and
  7. Xiuwei Chen, PhD*
  1. *Department of Gynecology, The Third Affiliated Hospital, and
  2. Department of Neurology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
  1. Address correspondence and reprint requests to Xiuwei Chen, PhD, Department of Gynecology, The Third Affiliated Hospital, Harbin Medical University, 150 Haping Rd, Harbin 150081, China. E-mail: chenxiuwei2014{at}


Objective Several inflammatory parameters are applied to predict the survival of patients with various cancers. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are 2 nonspecific markers of systemic inflammation. This study aimed to evaluate the clinicopathologic and prognostic values of NLR and PLR in patients with cervical cancer undergoing primary radical hysterectomy with pelvic lymphadenectomy.

Methods A total of 460 cervical cancer patients were enrolled in this study. These patients were histologically confirmed with cervical cancer from February 2005 to June 2008, at the Department of Gynecology, the Third Affiliated Hospital of Harbin Medical University, China. Their clinical and histopathological markers and complete blood counts were collected and analyzed. Prognostic factors were assessed by univariate and multivariate analyses.

Results The median NLR and PLR were 2.213 and 150.9, respectively. The clinicopathologic analysis showed that NLR was highly associated with depth of stromal infiltration (P = 0.007) and lymph node metastasis (P = 0.003), and PLR was significantly related to tumor size (P = 0.020) and lymph node metastasis (P = 0.027).

Univariate analysis identified high NLR as a statistically significant poor predictive factor for the progression-free survival (PFS) (P = 0.008) and overall survival (OS) (P = 0.014), and PLR exhibited no significance on PFS (P = 0.075) and OS (P = 0.110).

Multivariable analysis showed that the NLR was an independent prognostic marker for PFS (hazard ratio, 1.799; 95% confidence interval, 1.069–3.028; P = 0.027), but not for OS (hazard ratio, 1.631; 95% confidence interval, 0.968–2.750; P = 0.066).

Conclusions Preoperative NLR and PLR were found to be correlated to unfavorable histopathologic features of cervical cancer. The preoperative NLR, but not PLR, may be used as a potential and easy biomarker for survival prognosis in patients with cervical cancer receiving initial radical hysterectomy with pelvic lymphadenectomy.

  • Cervical cancer
  • Neutrophil-to-lymphocyte ratio (NLR)
  • Platelet-to-lymphocyte ratio (PLR)
  • Prognosis

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  • Supported by the Natural Science Foundation of Heilongjiang Province, China (H201336).

  • The authors declare no conflicts of interest.