Neutrophil-to-lymphocyte ratio as a predictor of progression in patients with early-stage cervical cancer

Aims: The neutrophil-to-lymphocyte ratio (NLR) has shown promise as a prognostic marker in various cancers, but its role in early-stage cervical cancer is not well defined. This study evaluates the association between pre-treatment NLR and progression risk in patients with early-stage cervical cancer. Methods: This retrospective study included 220 patients with stage I and II cervical cancer treated from 2010 to 2024. Patients with prior treatment, infection at diagnosis, or hematological diseases were excluded. Pre-treatment NLR was calculated from blood counts taken within a week before treatment. Primary outcome was progression-free survival (PFS). Cox regression analyses identified prognostic factors. Results: The median follow-up was 46 months (range, 1-120). Disease progression occurred in 17.3% of patients, and 15% died. The 5-year overall survival and PFS rates were 84.8% (95% CI: 79.3-90.3) and 77.7% (95% CI: 71.4-84), respectively. Univariate analysis identified non-squamous cell carcinoma (non-SCC) histology, tumor size >4 cm, and elevated NLR as significant factors affecting PFS. Multivariate analysis confirmed non-SCC histology (HR: 3.2, p=0.002), tumor size >4 cm (HR: 2.3, p=0.007), and elevated NLR (HR: 1.1, p=0.041) as independent PFS risk factors. Higher NLR correlated with larger tumor size. Conclusions: Elevated pre-treatment NLR independently predicts disease progression in early-stage cervical cancer. Incorporating NLR into risk stratification could enhance prognostic assessments and guide personalized treatments. Larger prospective studies are needed for validation.