INFLAMMATORY HEMATOLOGICAL MARKERS IN PREDICTION OF CERVICAL INTRAEPITHELIAL NEOPLASIA RECURRENCE IN NEGATIVE SURGICAL MARGINS
Year 2021,
Volume: 54 Issue: 1, 38 - 42, 27.04.2021
Ayçağ Yorgancı
,
Özlem Gündüz
,
Büşra Körpe
,
Banu Seven
,
Hakan Raşit Yalçın
,
Yaprak Ustun
Abstract
Objective: This study aimed to evaluate the predictive value of preoperative neutrophil-lymphocyte ratio in cervical intraepithelial neoplasia recurrence after conization surgery.
Materials and Methods: In this retrospective study, patients who underwent conization due to cervical intraepithelial neoplasia were analyzed. Inclusion criteria were cervical intraepithelial neoplasia in the conization specimen with negative surgical margins and at least 12 months follow-up period at our clinical database. Demographic, clinical, pathological data, and preoperative complete blood count findings of the patients were extracted from medical files.
Results: There were a total of 105 patients divided into two groups: the recurrence group (n = 30) and the control group (n =85). There were no statistically significant differences between the two groups in terms of cervical intraepithelial neoplasia pathology grades. There was statistically increased number of postconization endocervical positive results in the recurrence group. In the recurrence group, the mean of recurrence free survival was 10.5 months. There were no statistically significant differences in the preoperative neutrophil-lymphocyte ratio and in other hematologic parameters between the groups. In logistic regression analysis, only endocervical curettage positivity was predictive in estimating recurrence (p=0.002, %95 CI 0.084-0.365).
Conclusion: Preoperative neutrophil-lymphocyte ratio and other inflammatory markers were not predictive of recurrence after conization in women with negative surgical margins. Positive postconization endocervical curettage was the only prognostic factor associated with recurrence after excisional therapy.
References
- 1.) Mitra A, Tzafetas M, Lyons D, Fotopoulou C, Paraskevaidis E, Kyrgiou M. Cervical intraepithelial neoplasia: screening and management. Br J Hosp Med (Lond). 2016;77(8):C118-23.
- 2.) Bruno MT, Cassaro N, Garofalo S, Boemi S. HPV16 persistent infection and recurrent disease after LEEP. Virol J. 2019;16(1):148.
- 3.) Lu CH, Liu FS, Kuo CJ, Chang CC, Ho ES. Prediction of persistence or recurrence after conization for cervical intraepithelial neoplasia III. Obstet Gynecol. 2006;107(4):830-5.
- 4.) Chen L, Liu L, Tao X, Guo L, Zhang H, Sui L. Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization. J Low Genit Tract Dis. 2019;23(1):24-7.
- 5.) Serati M, Siesto G, Carollo S et al. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study. Eur J Obstet Gynecol Reprod Biol. 2012;165(1):86-90.
- 6.) Paraskevaidis E, Arbyn M, Sotiriadis A et al. The role of HPV DNA testing in the follow-up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev. 2004;30(2):205-11.
- 7.) Ayhan A, Tuncer HA, Reyhan NH, Kuscu E, Dursun P. Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins. Eur J Obstet Gynecol Reprod Biol. 2016;201:1-6.
- 8.) Kudela E, Holubekova V, Farkasova A, Danko J. Determination of malignant potential of cervical intraepithelial neoplasia. Tumour Biol. 2016;37(2):1521-5.
- 9.) Dupre A, Malik HZ. Inflammation and cancer: What a surgical oncologist should know. Eur J Surg Oncol. 2018;44(5):566-70.
- 10.) Huang QT, Man QQ, Hu J et al. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer: A systematic review and meta-analysis of observational studies. Oncotarget. 2017;8(10):16755-64.
- 11.) Nishijima TF, Muss HB, Shachar SS, Tamura K, Takamatsu Y. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: A systematic review and meta-analysis. Cancer Treat Rev. 2015;41(10):971-8.
- 12. Tang H, Lu W, Li B, Li C, Xu Y, Dong J. Prognostic significance of neutrophil-to-lymphocyte ratio in biliary tract cancers: a systematic review and meta-analysis. Oncotarget. 2017;8(22):36857-68.
- 13.) Bao Y, Yang M, Jin C et al. Preoperative Hematologic Inflammatory Markers as Prognostic Factors in Patients with Glioma. World Neurosurg. 2018;119:e710-e6.
- 14.) Donskov F. Immunomonitoring and prognostic relevance of neutrophils in clinical trials. Semin Cancer Biol. 2013;23(3):200-7.
- 15.) Moses K, Brandau S. Human neutrophils: Their role in cancer and relation to myeloid-derived suppressor cells. Semin Immunol. 2016;28(2):187-96.
- 16.) Chun S, Shin K, Kim KH et al. The Neutrophil-Lymphocyte Ratio Predicts Recurrence of Cervical Intraepithelial Neoplasia. J Cancer. 2017;8(12):2205-11.
- 17.) Farzaneh F, Faghih N, Hosseini MS, Arab M, Ashrafganjoei T, Bahman A. Evaluation of Neutrophil-Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence. Asian Pac J Cancer Prev. 2019;20(8):2365-72.
- 18.) Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007;8(11):985-93.
- 19.) Suzuki Y, Cho T, Mogami T et al. Evaluation of endocervical curettage with conization in diagnosis of endocervical lesions. J Obstet Gynaecol Res. 2017;43(4):723-8.
- 20.) Schneider P, von Orelli S, Roos M, Leo C, Fink D, Wyss P. The value of endocervical curettage after conization for cervical intraepithelial neoplasia. Ann Diagn Pathol. 2012;16(4):245-9.
- 21.) Shaco-Levy R, Meirovitz M, Eger G, Benharroch D, Dreiher J. Post-conization endocervical curettage for estimating the risk of persistent or recurrent high-grade dysplasia. Int J Gynaecol Obstet. 2013;121(1):49-52.
INFLAMMATORY HEMATOLOGICAL MARKERS IN PREDICTION OF CERVICAL INTRAEPITHELIAL NEOPLASIA RECURRENCE IN NEGATIVE SURGICAL MARGINS
Year 2021,
Volume: 54 Issue: 1, 38 - 42, 27.04.2021
Ayçağ Yorgancı
,
Özlem Gündüz
,
Büşra Körpe
,
Banu Seven
,
Hakan Raşit Yalçın
,
Yaprak Ustun
Abstract
Amaç: Bu çalışmada konizasyon cerrahisi sonrası servikal intraepitelyal neoplazi nüksünü öngörmede preoperatif nötrofil-lenfosit oranının prediktif değerinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu retrospektif çalışmada, servikal intraepitelyal neoplazi patolojisine bağlı konizasyon uygulanan hastalar analiz edildi. Çalışmaya konizasyon materyalinde servikal intraepitelyal neoplazi saptanıp cerrahi sınırları negatif olan ve klinik veri tabanımızda en az 12 aylık takip süresi olan hastalar dahil edildi. Hastaların demografik, klinik, patolojik verileri ve preoperatif tam kan sayımı bulguları tıbbi dosyalardan çıkarıldı.
Bulgular: Toplamda mevcut olan 105 hasta iki gruba ayrıldı: rekürrens grubu (n = 30) ve kontrol grubu (n = 85). İki grup arasında servikal intraepitelyal neoplazi patoloji dereceleri açısından istatistiksel olarak anlamlı fark yoktu. Rekürrens grubunda kontrol grubuna göre endoservikal küretaj pozitif sonuç sayısı artmıştı. Nüks grubunda rekürrenssiz sağkalım ortalaması 10.5 aydı. İki grup arasında preoperatif nötrofil-lenfosit oranı ve diğer hematolojik parametreler açısından istatistiksel olarak anlamlı fark yoktu. Lojistik regresyon analizinde rekürrens tahmininde sadece endoservikal küretaj pozitifliği belirleyici idi (p = 0.002,% 95 CI 0.084-0.365).
Sonuç: Preoperatif nötrofil-lenfosit oranı ve diğer inflamatuar belirteçler cerrahi sınırları temiz konizasyon olgularında nüksü öngörmede etkin bulunmamıştır. Pozitif postkonizasyon endoservikal küretaj, eksizyonel tedaviden sonra nüks ile ilişkili tek prognostik faktör olarak bulunmuştur.
References
- 1.) Mitra A, Tzafetas M, Lyons D, Fotopoulou C, Paraskevaidis E, Kyrgiou M. Cervical intraepithelial neoplasia: screening and management. Br J Hosp Med (Lond). 2016;77(8):C118-23.
- 2.) Bruno MT, Cassaro N, Garofalo S, Boemi S. HPV16 persistent infection and recurrent disease after LEEP. Virol J. 2019;16(1):148.
- 3.) Lu CH, Liu FS, Kuo CJ, Chang CC, Ho ES. Prediction of persistence or recurrence after conization for cervical intraepithelial neoplasia III. Obstet Gynecol. 2006;107(4):830-5.
- 4.) Chen L, Liu L, Tao X, Guo L, Zhang H, Sui L. Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization. J Low Genit Tract Dis. 2019;23(1):24-7.
- 5.) Serati M, Siesto G, Carollo S et al. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study. Eur J Obstet Gynecol Reprod Biol. 2012;165(1):86-90.
- 6.) Paraskevaidis E, Arbyn M, Sotiriadis A et al. The role of HPV DNA testing in the follow-up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev. 2004;30(2):205-11.
- 7.) Ayhan A, Tuncer HA, Reyhan NH, Kuscu E, Dursun P. Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins. Eur J Obstet Gynecol Reprod Biol. 2016;201:1-6.
- 8.) Kudela E, Holubekova V, Farkasova A, Danko J. Determination of malignant potential of cervical intraepithelial neoplasia. Tumour Biol. 2016;37(2):1521-5.
- 9.) Dupre A, Malik HZ. Inflammation and cancer: What a surgical oncologist should know. Eur J Surg Oncol. 2018;44(5):566-70.
- 10.) Huang QT, Man QQ, Hu J et al. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer: A systematic review and meta-analysis of observational studies. Oncotarget. 2017;8(10):16755-64.
- 11.) Nishijima TF, Muss HB, Shachar SS, Tamura K, Takamatsu Y. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: A systematic review and meta-analysis. Cancer Treat Rev. 2015;41(10):971-8.
- 12. Tang H, Lu W, Li B, Li C, Xu Y, Dong J. Prognostic significance of neutrophil-to-lymphocyte ratio in biliary tract cancers: a systematic review and meta-analysis. Oncotarget. 2017;8(22):36857-68.
- 13.) Bao Y, Yang M, Jin C et al. Preoperative Hematologic Inflammatory Markers as Prognostic Factors in Patients with Glioma. World Neurosurg. 2018;119:e710-e6.
- 14.) Donskov F. Immunomonitoring and prognostic relevance of neutrophils in clinical trials. Semin Cancer Biol. 2013;23(3):200-7.
- 15.) Moses K, Brandau S. Human neutrophils: Their role in cancer and relation to myeloid-derived suppressor cells. Semin Immunol. 2016;28(2):187-96.
- 16.) Chun S, Shin K, Kim KH et al. The Neutrophil-Lymphocyte Ratio Predicts Recurrence of Cervical Intraepithelial Neoplasia. J Cancer. 2017;8(12):2205-11.
- 17.) Farzaneh F, Faghih N, Hosseini MS, Arab M, Ashrafganjoei T, Bahman A. Evaluation of Neutrophil-Lymphocyte Ratio as a Prognostic Factor in Cervical Intraepithelial Neoplasia Recurrence. Asian Pac J Cancer Prev. 2019;20(8):2365-72.
- 18.) Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007;8(11):985-93.
- 19.) Suzuki Y, Cho T, Mogami T et al. Evaluation of endocervical curettage with conization in diagnosis of endocervical lesions. J Obstet Gynaecol Res. 2017;43(4):723-8.
- 20.) Schneider P, von Orelli S, Roos M, Leo C, Fink D, Wyss P. The value of endocervical curettage after conization for cervical intraepithelial neoplasia. Ann Diagn Pathol. 2012;16(4):245-9.
- 21.) Shaco-Levy R, Meirovitz M, Eger G, Benharroch D, Dreiher J. Post-conization endocervical curettage for estimating the risk of persistent or recurrent high-grade dysplasia. Int J Gynaecol Obstet. 2013;121(1):49-52.