Comparison Of Hematologic Parameters In Patients With Positive vs. Negative Surgical Margins After Conization

Öz

Aim: To evaluate the utility of complete blood count to predict positive surgical margins after cold knife conization CKC .Material and Methods: Woman who underwent CKC because of biopsy - proven high-grade squamous intraepithelial lesions HSIL between 2009 and 2013 were retrospectively analyzed. Out of 231 woman in total, primarily referring 63 surgical margin positive women were included as the study group Group 1 , 168 surgical margin negative women were selected as the control group Group 2 . The relation between the positive surgical margins and age, height of cone, depth of cone, diameter of cone, complete blood count parameters was assessed.Results: The mean age of the patients were 41.9 years. The conization result of all patients’ in Group 1 was HSIL. The conization results of Group 2 were microinvasive carcinoma, HSIL, low-grade squamous lesion LSIL and no residual disease for 5, 108, 35 and 20 patients, respectively. 52 women in Group 1 underwent either repeat excisional procedure or simple hysterectomy and 24 of them showed residual disease. There was no statistically significant difference in regard to neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and mean platelet volume MPV occurred between two groups p=0.7, p=0.96 and p=0.81 respectively .Conclusion: Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and MPV do not seem to be useful in predicting positive surgical margins after CKC.

Anahtar Kelimeler

• Cold knife conization,mean platelet volume,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,surgical margin

Konizasyon Sonrası Pozitif Ve Negatif Cerrahi Sınırı Olan Hastalarda Hematolojik Parametrelerin Karşılaştırılması

Öz

Giriş: Tam kan sayımı parametrelerinin soğuk konizasyon sonrası cerrahi sınır pozitifliğini predikte etmesindeki faydasının değerlendirilmesi.Gereç ve Yöntemler: 2009 – 2013 yılları arasında biyopsi tanısı yüksek grade skuamöz intraepitelyal lezyon olup soğuk konizasyon uygulanan hastalar retrospektif olarak incelendi. 63 cerrahi sınır pozitif hasta çalışma grubu Grup 1 ve 168 cerrahi sınır negatif hasta kontrol grubu Grup 2 olmak üzere toplamda 231 hasta çalışmaya dahil edildi. Pozitif cerrahi sınırlar ile yaş, koni boyu, koni derinliği, koni çapı ve tam kan sayımı parametrelerinin ilişkisi değerlendirildi.Bulgular: Hastaların ortalama yaşı 41.9’du. Grup 1’deki bütün hastaların konizasyon sonrası patoloji sonucu yüksek grade skuamöz intraepitelyal lezyondu. Grup 2’deki 5 hastanın konizasyon sonrası patoloji sonucu mikroinvaziv karsinom, 108 hastanın yüksek grade skuamöz intraepitelyal lezyon, 35 hastanın düşük grade skuamöz intraepitelyal lezyon ve 20 hastanın patoloji sonucu ise normal olarak raporlandı. Grup 1’deki 52 hastaya tekrar eksizyonel prosedür veya basit histerektomi uygulandı. Bu hastaların 24’ünde rezidüel hastalık saptandı. Her iki grup arasında nötrofil/lenfosit oranı, platelet/lenfosit oranı ve ortalama platelet volümü açısından istatistiksel olarak anlamlı bir farklılık saptanmadı Sırasıyla p=0.7, p=0.96 ve p=0.81 .Sonuç: Nötrofil/lenfosit oranı, platelet/lenfosit oranı ve ortalama platelet volümü soğuk konizasyon sonrası pozitif cerrahi sınırı predikte etmede faydalı olarak gözükmemektedir.

Anahtar Kelimeler

• Cerrahi sınır,nötrofil/lenfosit oranı,ortalama platelet volümü,platelet/lenfosit oranı,soğuk konizasyon

Kaynakça

1. 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;8:985-93.
2. Kietpeerakool C, Khunamornpong S, Srisomboon J, Siriaunkgul S, Suprasert P. Cervical intraepithelial neoplasia II-III with endocervical cone margin involvement after cervical loop conization: is there any predictor for residual disease? J Obstet Gynaecol Res 2007;33:660-4.
3. Simoens C, Goffin F, Simon P, Barlow P, Antoine J, Foidart JM, et al. Adverse obstetrical outcomes after treatment of precancerous cervical lesions: a Belgian multicentre study. BJOG 2012;119:1247-55.
4. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell 2010;140:883-99.
5. Pichler M, Hutterer GC, Stoeckigt C, Chromecki TF, Stojakovic T, Golbeck S, et al. Validation of the pre-treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer 2013;108:901-7.
6. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet- lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012;17:216-22.
7. Kai H, Kitadai Y, Kodama M, Cho S, Kuroda T, Ito M, et al. Involvement of proinflammatory cytokines IL-1beta and IL-6 in progression of human gastric carcinoma. Anticancer Res 2005;25:709-13.
8. Heras P, Hatzopoulos A, Kritikos N, Kritikos K. Platelet count and tumor progression in gastric cancer patients. Scand J Gastroenterol 2010;45:1005-6.

9. Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291-4.
10. Nam K, Kwak J, Kim J, Jeon S. Human papillomavirus type 16 causes larger colposcopic lesions than other HPV types in patients with grade 3 cervical intraepithelial neoplasia. J Low Genit Tract Dis 2013;17:1-5.
11. Yun ZY, Zhang X, Liu ZP, Liu T, Wang RT, Chen H. Association of decreased mean platelet volume with renal cell carcinoma. Int J Clin Oncol 2017.
12. Hammes LS, Tekmal RR, Naud P, Edelweiss MI, Kirma N, Valente PT, et al. Macrophages, inflammation and risk of cervical intraepithelial neoplasia (CIN) progression--clinicopathological correlation. Gynecol Oncol 2007;105:157-65.
13. Pahler JC, Tazzyman S, Erez N, Chen YY, Murdoch C, Nozawa H, et al. Plasticity in tumor-promoting inflammation: impairment of macrophage recruitment evokes a compensatory neutrophil response. Neoplasia 2008;10:329-40.
14. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860- 7.
15. Kose M, Celik F, Kose SK, Arioz DT, Yilmazer M. Could the platelet- to-lymphocyte ratio be a novel marker for predicting invasiveness of cervical pathologies? Asian Pac J Cancer Prev 2015;16:923-6.
16. Tavares-Murta BM, Mendonca MA, Duarte NL, da Silva JA, Mutao TS, Garcia CB, et al. Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer 2010;20:1154-9.
17. Smith RA, Bosonnet L, Ghaneh P, Sutton R, Evans J, Healey P, et al. The platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery 2008;143:658-66.
18. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol 2012;23:265-73.
19. Acmaz G, Aksoy H, Unal D, Ozyurt S, Cingillioglu B, Aksoy U, et al. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev 2014;15:1689-92.
20. Zhang Y, Wang L, Liu Y, Wang S, Shang P, Gao Y, et al. Preoperative neutrophil-lymphocyte ratio before platelet-lymphocyte ratio predicts clinical outcome in patients with cervical cancer treated with initial radical surgery. Int J Gynecol Cancer 2014;24:1319-25.
21. Threatte GA. Usefulness of the mean platelet volume. Clin Lab Med 1993;13:937-50.
22. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47-58.
23. Oge T, Yalcin OT, Ozalp SS, Isikci T. Platelet volume as a parameter for platelet activation in patients with endometrial cancer. J Obstet Gynaecol 2013;33:301-4.
24. Tasci T, Turan T, Ureyen I, Karalok A, Kalyoncu R, Boran N, et al. Is there any predictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervical cancer? J Low Genit Tract Dis 2015;19:115-8.
25. Diaz ES, Aoyama C, Baquing MA, Beavis A, Silva E, Holschneider C, et al. Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins. Gynecol Oncol 2014;132:76-80.