The objective of this study is twofold. Firstly, it will investigate the changes in the levels of immune-inflammatory factors before and after lymph node resection in patients with gynecological malignancies, and their clinical significance. Secondly, it will provide a theoretical basis for clinical, individualized therapy. A total of 90 patients diagnosed with gynecological malignancies were selected for this study. These patients were diagnosed in the gynecology department of a tertiary general hospital from August 2024 to June 2026. The study included 30 cases of cervical cancer (CC), 30 cases of endometrial cancer (EC), and 30 cases of ovarian cancer (OC). The patients were divided into two groups, a lymph node biopsy (LNB) group and a lymph node dissection (LND) group, according to the type of gynecological malignancy and specific disease characteristics, and with reference to international authoritative guidelines. The number of patients in each group was 45. All patients received standardized treatment according to the relevant guidelines and expert consensus for each type of malignancy. 10 ml of peripheral venous blood was collected on an empty stomach 1 day before lymph node resection, 3 days after discontinuing antibiotics after surgery, and 3 months after surgery. The proportions of T lymphocytes and natural killer (NK) cells, in addition to the levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were detected. All patients included in the study were closely observed post-surgery, with survival status information collected. The relapse-free survival (RFS) and overall survival (OS) of the patients were calculated. There were no statistically significant disparities between the two patient groups with regard to age, BMI, menopausal status, and marital status (P > 0.05). However, significant differences were observed in indicators such as pathological FIGO stage, tumor size, number of dissected lymph nodes, and maximum lymph node diameter (P < 0.05). Prior to undergoing surgical intervention, no statistically significant disparities were observed in the levels of IL-6, TNF-α, and immune factor indicators between the two groups. Three days after surgery, the increase in IL-6 and TNF-α in the dissection group was more significant. The decrease in CD3 + and CD4+ cells was considerably more pronounced than that observed in the biopsy group, while the decline in the CD4+/CD8+ ratio was more evident and the decrease in CD16 + CD56 + cells was more substantial. Three months after surgery, the inflammatory indicators of the two groups were close to the preoperative levels, but the immune factor indicators had not yet returned to the preoperative state. The levels of CD4+ and CD16+CD56+ in the dissection group were still lower than those in the biopsy group (P < 0.05). Univariate analysis demonstrated a significant correlation between stages Ⅳ and Ⅳ of the pathological FIGO stage and tumor size with RFS. Multivariate analysis further confirmed that stage Ⅳ (hazard ratio HR = 32.277, P < 0.01), stage Ⅳ (HR = 36.624, P < 0.001), and CD4 + at 3 months after surgery (HR = 0.848, P < 0.01) were significantly associated with RFS. In univariate analysis, stages Ⅲ and Ⅳ of the pathological FIGO stage, tumor size, and a history of diabetes were associated with OS. Multivariate analysis indicated that CD16+CD56+ at 3 months after surgery was an independent key factor affecting OS (HR = 0.490, P < 0.01). Lymph node resection in gynecological malignancy patients is associated with changes in inflammatory and immune factors. The LND group is associated with a stronger early post-surgery inflammatory response, more significant changes in immune factors, more obvious immunosuppression, and slower recovery. The CD4+ level at 3 months post-surgery is associated with RFS, and CD16+CD56+ is associated with OS. These immune indicators help clinicians assess prognosis and plan individualized therapy.
Ren et al. (Sun,) studied this question.