HPV 16/18 Pozitif Kadınlarda CIN3 Tanısında Sistemik Enflamatuvar Belirteçlerin Yeri: Retrospektif Bir Çalışma

Year 2026, Volume: 26 Issue: 1 , 1 - 8 , 22.04.2026

Cem Yağmur Özdemir , Nayif Çiçekli , Ahmet Orhan Gürer , Nagihan Özdemir , Elif Canseven , Cevdet Doğu , Dağıstan Tolga Arıöz

https://izlik.org/JA67FL72FE

Abstract

ÖZET Amaç: Bu çalışmada, HPV 16 ve/veya 18 pozitif kadınlarda sistemik immün-inflamasyon indeksinin (SII) CIN3+ lezyonları bağımsız olarak öngörüp öngöremeyeceğinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Retrospektif olarak tasarlanan bu çalışmaya, kolposkopik biyopsi yapılan ve HPV 16 ve/veya 18 pozitifliği saptanan 203 kadın dahil edildi. Biyopsi öncesi tam kan sayımı parametrelerinden nötrofil-lenfosit oranı, trombosit-lenfosit oranı ve sistemik immün-inflamasyon indeksi hesaplandı. CIN3+ öngörüsünde SII’nin performansı için ROC eğrisi analizi yapıldı ve optimal eşik değer Youden indeksi ile belirlendi. Bağımsız ilişkiyi değerlendirmek amacıyla çok değişkenli lojistik regresyon analizi uygulandı. Sonuçlar: Hastaların %19,7’sinde CIN3+ saptandı. Değerlendirilen inflamatuvar belirteçler arasında yalnızca SII ile CIN3+ arasında anlamlı ilişki bulundu (p=0,004). Eğri altında kalan alan 0,647 olarak hesaplandı. 809,450 eşik değeri için duyarlılık %77,5 ve özgüllük %48,4 idi. Çok değişkenli analizde SII ≥809,450 değeri CIN3+ ile bağımsız olarak ilişkili bulundu (OR: 3,24; %95 GA: 1,45–7,23; p=0,004). Modelin açıklayıcılığı sınırlıydı (Nagelkerke R²=0,072). Tartışma: Sistemik immün-inflamasyon indeksi HPV 16 ve/veya 18 pozitif kadınlarda CIN3+ ile bağımsız olarak ilişkili bulunmuştur; ancak öngörü gücü sınırlıdır. SII, risk temelli değerlendirme modellerinde tamamlayıcı bir parametre olarak değerlendirilebilir. Anahtar Sözcükler: Servikal intraepitelyal neoplazi, insan papilloma virüsü, sistemik immün-inflamasyon indeksi, inflamasyon belirteçleri

Keywords

Servikal intraepitelyal neoplazi , insan papilloma virüsü , sistemik immün-inflamasyon indeksi

Ethical Statement

Bu çalışma, Afyonkarahisar Sağlık Bilimleri Üniversitesi Hastanesi Etik Kurulu tarafından onaylanmıştır (onay no: 2025/8 – tarih: 13.06.2025). Çalışma, Helsinki Bildirgesi'ne uygun olarak yürütülmüştür. Bu çalışma için gerekli kurumsal izinler, Afyonkarahisar İl Sağlık Müdürlüğü ve Afyonkarahisar Devlet Hastanesi'nden alınmıştır.

Supporting Institution

Bu araştırma herhangi bir dış finansman almamıştır.

Thanks

Bu çalışmayı, Türkiye'de jinekolojik onkolojinin öncülerinden, bilimsel titizliği ve kadın kanseri tedavisini geliştirme konusundaki kararlılığıyla nesiller boyu klinisyen ve araştırmacıya yol gösteren Prof. Dr. Ali Ayhan'ın anısına ithaf ediyoruz.

The Association Between Systemic Inflammatory Markers and CIN3+ in Women Positive for HPV 16/18: A Retrospective Study

https://izlik.org/JA67FL72FE

Abstract

ABSTRACT Objective: To evaluate whether the systemic immune-inflammation index (SII) independently predicts CIN3+ lesions in women positive for HPV 16 and/or 18. Methods: This retrospective study included 203 women aged 25 to 65 years with confirmed HPV 16 and/or 18 positivity who underwent colposcopic biopsy. Pre-biopsy complete blood count parameters were used to calculate neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII. Receiver operating characteristic curve analysis was performed to determine the optimal SII cut-off for predicting CIN3+. Multivariate logistic regression analysis was used to assess whether SII independently predicted CIN3+ after adjustment for age, HPV genotype, and hemoglobin level. Results: Among the evaluated markers, only SII demonstrated a statistically significant association with CIN3+ (p = 0.004). The area under the curve was 0.647. An optimal cut-off value of 809.450 yielded 77.5% sensitivity and 48.4% specificity. In multivariate analysis, SII values at or above this threshold were independently associated with CIN3+ (odds ratio 3.24, 95% confidence interval 1.45 to 7.23; p = 0.004). However, the overall explanatory power of the model was limited (Nagelkerke R² = 0.072). Conclusion: SII was independently associated with CIN3+ in women positive for HPV 16 and/or 18, although its discriminatory capacity was modest. While insufficient as a standalone triage tool, SII may provide incremental value within multifactorial risk stratification models. Prospective validation studies are warranted. Keywords: Cervical intraepithelial neoplasia, human papillomavirus, systemic inflammation markers

Keywords

Cervical intraepithelial neoplasia , human papillomavirus , systemic inflammation markers

Ethical Statement

The present study was approved by the Ethical Committee of Afyonkarahisar Health Sciences University Hospital (grant no: 2025/8 – date: 13.06.2025). The study was conducted in accordance with the Declaration of Helsinki. The necessary institutional permissions for this study were obtained from Afyonkarahisar Provincial Health Directorate and Afyonkarahisar State Hospital.

Supporting Institution

This research received no external funding.

Thanks

We dedicate this study to the memory of Prof. Dr. Ali Ayhan, a pioneer of gynecologic oncology in Türkiye, whose scientific rigor and commitment to advancing women’s cancer care shaped generations of clinicians and researchers.

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