Preoperative Neutrophil to Lymphocyte Ratio (NLR) Can Predicts High Risk Surgicopathological Features in Patients of Early Stage Cervical Cancer (stage IB to IIA) Treated by Radical Hysterectomy with Pelvic Lymphadenectomy

Introduction: Globally cervical cancer is the 4th most common cancer in females after breast, colorectal, and lung cancer. In patients with early-stage cervical cancer (stage IB-IIA) who have undergone radical hysterectomy, postoperative histopathologic features along with clinical staging predict prognosis and are used for planning further treatment. Neutrophil-lymphocyte ratio (NLR) is a nonspecific marker to predict prognosis. This study aimed to evaluate the predictive values of preoperative values of NLR for high-risk surgical-pathological features identification in patients with early-stage cervical cancer undergoing primary radical hysterectomy with pelvic lymphadenectomy. Methods: This cross-sectional study was carried out in the Department of Gynaecological Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU) between July 2019 and June 2020 to evaluate the relationship of preoperative NLR with surgical-pathological features of cervical cancer stage IB-IIA who underwent primary radical hysterectomy and pelvic lymph node dissection. A total of fifty cervical cancer patients were enrolled in this study. Their clinical and histopathological findings and complete blood count reports were collected and analyzed. Result: The ROC curve revealed NLR was 2.670 (sensitivity 63%; specificity 91.3%; Areas under the curves 0.801). Surgical pathological analysis showed that NLR was linked to lymphovascular space invasion. Sixty-three percent of patients having NLR >2.670 were 17.85 times more likely to have LVSI. Conclusion: The study findings conclude that high pretreatment NLR was linked to lymphovascular space invasion. Thus NLR can be used preoperatively to predict the prognosis of cancer cervix and triage the patients into monovalent treatment- either surgery or chemoradiation.