Association of the Neutrophil-to-Lymphocyte Ratio (NLR) with Survival in Locally Advanced and Metastatic Cervical Cancer: A Longitudinal, Retrospective Study
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Copyright (c) 2025 Edison Alberto Carrasco-Rubio, Henry Marcel Caballero Narváez
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
DOI:
https://doi.org/10.33821/778Keywords:
cervical cancer, lymphocytes, neutrophils, survival, indexAbstract
Introduction: Cervical cancer is one of the gynecological tumors with the highest mortality rates. Inflammation plays a crucial role in its initiation and metastatic progression. The neutrophil-to-lymphocyte ratio (NLR) reflects the balance between the tumor and the antitumoral immune response, positioning it as a relevant prognostic factor. Given the high lethality of this cancer, the evaluation of NLR allows for proper patient stratification, facilitating personalized treatment and, consequently, optimizing healthcare resources and costs. Materials and Methods: Observational, descriptive study of historical cohorts at the SOLCA Oncology Hospital, Quito, in patients diagnosed with locally advanced (IB2 - IVA) and metastatic (IVB) cervical cancer from January 2010 to 2018. These were anonymized according to current and updated legal regulations. Results: The study population included 672 patients with a 180-month follow-up, and the neutrophil-to-lymphocyte ratio was assessed before treatment. Values less than 2.5 were associated with longer overall survival and late recurrence, with data of 37 months (95% CI 26.3–47.6; p < 0.05) and 30 months (95% CI 9.4–50.5; p < 0.05), respectively. Furthermore, a neutrophil-to-lymphocyte ratio ? 2.5 is a predictor of recurrence. The hazard ratio (HR) for mortality is 3.09 (95% CI 2.42 to 3.94; p < 0.05) and for recurrence, HR = 3.16 (95% CI 2.47 to 4.05; p < 0.05). Similarly, the Moore criteria, in the intermediate-high risk group, mortality HR 5.39 and recurrence HR 10.66, both p 0.000. Conclusions: NLR less than 2.5 is associated with better overall survival and shorter time to recurrence. NLR ?2.5 is associated with more aggressive tumor behavior with a tendency toward early recurrence and higher mortality.
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