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

Background and Aim : Background: Immune system status is a factor related to cervical intraepithelialneoplasia (CIN) recurrence. neutrophil-lymphocyte ratio (NLR) is a useful factor in assessing the immunestatus. The aim of this study was to evaluate the prognostic value of NLR factor for CIN recurrence inpatient 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 (confrmed by excisionalpathology) from 2009 to 2017 were selected. NLR and hematologic factors were measured before surgeryand the follow-up records of these patient were analyzed. The recurrence rate and RFS were assessed duringthe follow-up phase.Results : The NLR cut-off point of 1.9 was determined using the Youden Index. NLR<1.9 (low NLR) andNLR 1.9 (high NLR) were observed among 68.1% and 39.1% of patients, respectively. Univariate analysisshowed that higher NLR values (P<0.001), absolute neutrophilic counts (ANC) (P<0.001) and plateletlymphocytic ratios (PLR) (P=0.002) were signifcantly associated with reduction in RFS. The results of Coxregression showed that removing more tissue during excision (HR = 0.325; 95% CI (0.936-0.136)signifcantly reduced the hazard of recurrence, higher NLR (HR = 4.55; 95% CI) (1.97-10.51) and whiteblood cell (WBC) count levels (HR =1.27; 95% CI, 1.04-1.55), signifcantly decreased RFS, but PLR andANC associated with RFS were not confrmed by Cox regression.Conclusion : NLR and total WBC count might be prognostic factors involved in the prediction ofrecurrence and RFS in CIN patient underwent excisional procedure. To confrm these results, moreprospective studies with larger sample sizes are needed.