FIGO stage typifies tumor progression according to the results of clinical and imaging examinations, and this is an important means for prognosis prediction of patients with cervical cancer.[14–15] Recent studies have shown that inflammation plays an important role in the occurrence and development of cervical cancer. Hematological markers related to inflammation in complete blood cell count may help in the evaluation of the prognosis of patients.
Inflammatory response is caused by inflammatory cells and a series of inflammatory mediators. Chronic inflammation is an important cause of immunosuppression in the tumor microenvironment. Inflammatory cells and cytokines or chemokines are involved in almost every step of tumor development. Inflammatory response caused by tumors can lead to hematological changes, including relative neutrophilia, thrombocytosis, and lymphocytopenia. Therefore, patients with high NLR and PLR usually have severe systemic inflammatory responses, poor antitumor activities, and strong tumor invasiveness. Moreover, assessment of the NLR and PLR has the advantages of low cost, simple operation, and high repeatability. Several studies have shown that the NLR and PLR can be used to predict the prognosis of patients with malignant tumors.[10–13] Such indicators have also been proven to be clinically relevant for cervical cancer. Lu et al.  analyzed the prognosis of 120 patients diagnosed with cervical cancer and found that the systemic immune inflammation index influences patient survival and that the NLR and PLR are important factors that affect the OS rate. Zhang et al.  also found the NLR was an independent prognostic indicator of progression-free survival(PFS) of patients with cervical cancer. Consistent with previous studies, this study confirmed that such indicators can be used to predict the prognosis of patients with cervical cancer. The results of this study showed that the survival times of the high NLR and PLR groups were significantly lower than those of the low NLR and PLR groups. The 3-year OS rates of the high and low NLR groups were 60.7% and 86.3%, respectively. The 5-year OS rates of the high and low NLR groups were 51.7% and 83.3%, respectively (x2 value 11.997, P=0.001). The 3-year OS rates of the high and low PLR groups were 61.1% and 89.0%, respectively. The 5-year OS rates of the high and low PLR groups were 57.9% and 83.8%, respectively (x2 value 10.106, P=0.001). Univariate analysis showed that both the NLR and PLR before radiotherapy were factors that were significantly associated with the prognosis of patients with cervical cancer. However, multivariate analysis showed that the NLR before radiotherapy was not an independent risk factor for the prognosis of patients with cervical cancer. The reason may be that the NLR value is significantly affected by the tumor stage (Fig. 4). The later the FIGO stage the more serious the systemic inflammatory response and the higher the NLR in peripheral blood.
This paper has the following limitations. First, this was a retrospective study. Some information were missing or inaccurate, which may have introduced bias. Some patients were rechecked in different places or other hospitals, and the information could not be collected completely and accurately. This resulted in a small sample size. Therefore, the results need to be interpreted carefully. Even so, this study still reflects the possibility that the NLR and PLR can be used as biological indicators to predict the prognosis of patients with cervical cancer.