中性粒细胞-淋巴细胞比值(NLR)在切除治疗后 CIN2+ 2 复发预后中的作用。

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Gynecologic and Obstetric Investigation Pub Date : 2024-01-01 Epub Date: 2024-03-18 DOI:10.1159/000534790
Mattia Dominoni, Amelia Barcellini, Marianna Francesca Pasquali, Annalisa De Silvestri, Virginia Valeria Ferretti, Stefania Cesari, Giacomo Fiandrino, Ester Orlandi, Barbara Gardella
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引用次数: 0

摘要

目的:CIN2+ 治疗后复发的主要风险因素是 HPV 持续感染。免疫系统失调只允许 HR-HPV 持续感染,促进癌症发展,增加治疗后复发的风险。因此,在癌变过程中,细胞因子模式向 Th2 型转变;为此,中性粒细胞-淋巴细胞比值(NLR)可作为这种免疫学变化的标志物。本研究的目的是在现实生活中对接受过 CIN2+ 治疗的患者进行切除治疗后,分析 NLR 对高级别 CIN(CIN2+)复发的预测作用:我们对 2011 年至 2020 年期间因子宫颈抹片筛查异常而到我科阴道镜服务处就诊的 444 名患者的回顾性数据库进行了研究,并将其临床特征与诊断时进行的 NLR 进行了比较。所有接受分析的患者都按照既定方案接受了治疗(头两年每 6 个月接受一次阴道镜检查,三年后每年接受一次),并在入院时和随访结束时进行了 HPV DNA 检测和宫颈活检。所有患者都接受了血样检查,包括全血细胞计数和以 103/ml 表示的中性粒细胞和淋巴细胞收集值。结果 NLR截断点1.34对诊断CIN2+复发的敏感性(SE)和特异性(SP)分别为0.76和0.67。我们发现,NLR<1.34的患者CIN2+复发率明显更高(3.7% vs. 0.6%,P=0.033),NLR≥1.34的患者5年无复发生存率更高(97% vs. 93%,P=0.030)。局限性 首先,回顾性分析和较低的复发率可能会限制结论的得出。其次,由于是回顾性研究,我们没有考虑患者的合并症和生活习惯(吸烟),这可能会影响 NLR。另一方面,我们研究的中位随访时间为 26 个月(IQR 22-31),这充分反映了复发的发生率。结论 众所周知,CIN2+病变是由持续的人乳头瘤病毒感染导致的免疫系统失调引起的,这可能会导致宫颈癌。因此,NRL 可以作为预测复发风险(尤其是高级别宫颈病变的复发风险)的可靠而经济的生物标志物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Role of Neutrophil-Lymphocytes Ratio in the Prognosis of CIN2+ Recurrence after Excisional Treatment.

Objectives: The main risk factor involved in CIN2+ recurrence after treatment is the HPV persistent infection. The dysregulation of the immune system permits only HR-HPVs to become persistent infections, to promote cancer development, and to increase the risk of recurrence after treatment. Therefore, there is a shift to a Th2-type cytokine pattern during the carcinogenesis pathway; for this reason, the neutrophil-lymphocytes ratio (NLR) could be a marker of this immunological change. The study aimed to analyse the predictive role of NLR in the recurrence of high-grade CIN (CIN2+) after excisional treatment in a real-world life setting of patients treated for CIN2+.

Design: This study wascross-sectional study.

Participants/materials, setting, methods: We examined a retrospective database of 444 patients, who attended the colposcopy service of our department from 2011 to 2020 due to an abnormal screening Pap smear, and we compared the clinical characteristics to NLR performed at the time of diagnosis. All analysed patients were treated according to an established protocol (colposcopy every 6 months for the first 2 years and every year for over 3 years) and HPV-DNA test and cervical biopsy were performed at entry and the end of follow-up. All patients underwent a blood sample examination, including complete white blood cell counts and collecting neutrophil and lymphocyte values expressed as 103/mL.

Results: The sensitivity (SE) and specificity (SP) of the NLR cut-off point of 1.34 for the diagnosis of CIN2+ recurrence were 0.76 and 0.67, respectively. We found that CIN2+ recurrences were significantly higher in patients with NLR <1.34 (3.7% vs. 0.6%, p = 0.033) and the 5-year recurrence-free survival was higher in patients with NLR ≥1.34 (97% vs. 93%, p = 0.030).

Limitations: Firstly, the retrospective analysis and low incidence of recurrence may limit the conclusions. Second, for the retrospective design of the study, we did not take into consideration the patient's comorbidities and habits (smoking) that may influence the NLR. On the other hand, the median duration of follow-up in our study was 26 months (IQR: 22-31), which fully reflects the incidence of recurrences.

Conclusions: It is well known that CIN2+ lesions are sustained by deregulation of the immune system caused by persistent HPV infection, which may lead to cervical cancer. Among the actors underlying dysregulation of immunity, lymphocytes are involved in the permission of persistent infection and for this reason, NRL could be a reliable and cost-effective biomarker in predicting the risk of recurrence, especially for high-grade cervical lesions.

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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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