Cervical intraepithelial neoplasia (cin) and the importance of leukocytes, platelets, mean platelet volume, platelet distribution width, red cell distribution width, plateletcrit, neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte ratios in diagnosis

Öz

Aim: Cervical intraepithelial neoplasia (CIN) is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. In this study, we investigated whether hematological parameters, such as White Blood Cell Count (WBC), Platelet Count (PLT), Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Red Blood Cell Distribution Width (RDW), Plateletcrit (PCT), Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), and Lymphocyte/Monocyte Ratio (LMR), which are useful in predicting the risk of developing cervical lesions. Materials and Methods: The study is retrospective. The hematological parameters (WBC, PLT, MPV, PDW, RDW, PCT, NLR, PLR, and LMR) of female patients aged 18-65, who visited the Istanbul Training and Research Hospital Gynecology and Obstetrics Clinic between 01/01/2012 and 31/12/2023, and were histologically confirmed to have CIN I, CIN II, or CIN III based on colposcopy results, were compared. These inflammatory indices were calculated based on complete blood counts taken at diagnosis. Results: When examining the comparisons made in our study, there was no significant difference in the age of patients among the CIN I, CIN II, and CIN III groups because of LEEP/Conization (p>0.05). There were no significant differences in hematological parameters; WBC, PLT, MPV, PDW, RDW, PCT values, and Neutrophil/Lymphocyte, Platelet/Lymphocyte, and Lymphocyte/Monocyte Ratios among the CIN I, CIN II, and CIN III groups (p>0.05). Conclusion: In this study, we compared hematological parameters among CIN I, CIN II, and CIN III patients to prevent overtreatment of CIN1, CIN2, and CIN3 patients and to predict the onset of invasive cervical cancer at an early stage. We did not find a significant difference. However, large-scale, multicenter studies and long-term validation are required for clinical practice.

Anahtar Kelimeler

• Cervical Intraepithelial Neoplasia
• Lymphocyte/Monocyte
• Neutrophil/Lymphocyte
• Platelet/Lymphocyte

Destekleyen Kurum

The authors have declared that there is no conflict of interest.

Etik Beyan

Ethical approval was obtained from the Non-Interventional Clinical Research Ethics Committee of Istanbul Training and Research Hospital with the decision number 283 dated 27.10.2023.

Servikal i̇ntraepitelyal neoplazilerde lökosit,trombosit, ortalama trombosit hacmi,trombosit dağılım genişliği, eritrosit dağılım genişliği , plateletcrit, nötrofil/lenfosit,trombosit/lenfosit, lenfosit/monosit oranı ve tanıda önemi

Öz

Amaç: Bu çalışmanın amacı, hematolojik parametrelerin—beyaz kan hücresi sayısı (WBC), trombosit sayısı (PLT), ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW), kırmızı kan hücresi dağılım genişliği (RDW), trombosit krit (PCT), nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR) ve lenfosit/monosit oranı (LMR)—servikal intraepitelyal neoplazi (CIN) riski ve CIN’in evreleri arasındaki farkları tahmin etmedeki geçerliliğini araştırmaktır. Materyal ve Yöntem: Bu retrospektif çalışmada, 1 Ocak 2012 ile 31 Aralık 2023 tarihleri arasında İstanbul Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’ne başvuran, yaşları 18-65 arasında değişen ve kolposkopi sonuçlarına göre histolojik olarak CIN I, CIN II veya CIN III olarak tanı konmuş kadın hastaların hematolojik parametreleri incelenmiştir. Hematolojik indeksler, tanı anında alınan tam kan sayımı sonuçlarına dayandırılmıştır. Bulgular: Çalışmamızda, CIN I, CIN II ve CIN III grupları arasında yaş açısından anlamlı bir fark bulunmamıştır (p>0,05). Ayrıca, WBC, PLT, MPV, PDW, RDW, PCT, NLR, PLR ve LMR değerleri açısından CIN I, CIN II ve CIN III grupları arasında anlamlı bir farklılık tespit edilmemiştir (p>0,05). Sonuç: Bu çalışmada, CIN I, CIN II ve CIN III evreleri arasındaki hematolojik parametrelerin anlamlı farklılıklar göstermediği bulunmuştur. Bu durum, bu parametrelerin CIN’in ilerleyişini veya invaziv servikal kanser riskini tahmin etmede güvenilir göstergeler olmayabileceğini düşündürmektedir. Gelecek araştırmalar için büyük ölçekli, çok merkezli ve uzun vadeli çalışmalar yapılması gerekmektedir.

Anahtar Kelimeler

• Servikal İntraepitelyal Neoplazi
• Lenfosit/Monosit Oranı
• Nötrofil/Lenfosit Oranı
• Trombosit/Lenfosit Oranı

Kaynakça

1. Richart RM. Natural history of cervical intraepithelial neoplasia. Clin Obstet Gynecol. 1968;10:748.
2. Global cancer facts and figures. http://www.cancer.org/downloads/STT/Global_Cancer_Facts_andFigures_2007_rev.pdf
3. Garcia F, Hatch KD, Berek JS. Intraepithelial Disease of the Cervix, Vagina, and Vulva. In: BerekJS, editor. Berek & Novak’s Gynecology, 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 574–618.
4. Xu L, Song J. Elevated neutrophil-lymphocyte ratio can be a biomarker for predicting the development of cervical intra-epithelial neoplasia. Medicine (Baltimore). 2021 Jul 16;100(28):e26335. doi: 10.1097/MD.0000000000026335. PMID: 34260524; PMCID: PMC8284729.
5. Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, Petry KU, Leeson S, Bergeron C, Nieminen P, Gondry J, Reich O, Moss EL. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol. 2017 Dec;18(12):1665-1679. doi: 10.1016/S1470-2045(17)30700-3. Epub 2017 Nov 7. PMID: 29126708.
6. Ostör AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993 Apr;12(2):186-92. PMID: 8463044.
7. Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and Cancer: Causes and Consequences. Clin Pharmacol Ther (2010) 87(4):504–8. doi: 10.1038/clpt.2009.254
8. Jaiswal M, LaRusso NF, Burgart LJ, et al.. Inflammatory cytokines induce DNA damage and inhibit DNA repair in cholangi-ocarcinoma cells by a nitric oxide-dependent mechanism. Cancer Res 2000;60:184–90.

9. Vural F, Coşkun ADE, Çıtak G, Vural B, Köse G. The comparison of inflammatory markers in geriatric and non-geriatric en-dometrial cancers. Cancer Biomark. 2022;34(4):583–590. doi: 10.3233/CBM-210215
10. Ishibashi Y, Tsujimoto H, Sugasawa H, Kouzu K, Itazaki Y, Sugihara T, Harada M, Ito N, Kishi Y, Ueno H. Prognostic value of platelet-related measures for overall survival in esophageal squamous cell carcinoma: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2021 Aug;164:103427. doi: 10.1016/j.critrevonc.2021.103427. Epub 2021 Jul 14. PMID: 34273499.
11. Zhang X, Niu Y, Wang X, Liu ZP, Liu T, Wang RT. Mean Platelet Volume and Platelet Distribution Width Are Associated with Gallbladder Cancer. Asian Pac J Cancer Prev. 2018 Feb 26;19(2):351-355. doi: 10.22034/APJCP.2018.19.2.351. PMID: 29479973; PMCID: PMC5980919.
12. Lu F, Pan S, Qi Y, Li X, Wang J. The Clinical Application Value of RDW, CA153, and MPV in Breast Cancer. Clin Lab. 2021 Feb 1;67(2). doi: 10.7754/Clin.Lab.2020.200507. PMID: 33616344.
13. Chadha AS, Koçak-Uzel E, Das P, et al. Paraneoplastik trombositoz, lokal ileri pankreas kanserli hastalarda bağımsız olarak kötü prognozu öngörür. Acta Oncol. 2015; 54:971–8.
14. Chen H, Wu X, Wen Z, Zhu Y, Liao L, Yang J. The Clinicopathological and Prognostic Value of NLR, PLR and MLR in Non-Muscular Invasive Bladder Cancer. Arch Esp Urol. 2022 Jun;75(5):467-471. doi: 10.56434/j.arch.esp.urol.20227505.68. PMID: 35983820.
15. Xiong S, Dong L, Cheng L. Neutrophils in cancer carcinogenesis and metastasis. J Hematol Oncol. 2021 Oct 21;14(1):173. doi: 10.1186/s13045-021-01187-y. PMID: 34674757; PMCID: PMC8529570
16. Cupp, M.A.; Cariolou, M.; Tzoulaki, İ.; Aune, D.; Evangelou, E.; Berlanga-Taylor, A.J. Nötrofil/lenfosit oranı ve kanser prog-nozu: Gözlemsel çalışmaların sistematik incelemeleri ve meta-analizlerinin bir şemsiye incelemesi. BMC Med. 2020, 18, 360.
17. Hirahara N, Matsubara T, Kaji S, Hayashi H, Sasaki Y, Kawakami K, Hyakudomi R, Yamamoto T, Tajima Y. Novel inflamma-tion-combined prognostic index to predict survival outcomes in patients with gastric cancer. Oncotarget. 2023 Jan 31;14:71-82. doi: 10.18632/oncotarget.28353. PMID: 36719281; PMCID: PMC9888308.
18. Kumarasamy C, Tiwary V, Sunil K, Suresh D, Shetty S, Muthukaliannan GK, Baxi S, Jayaraj R. Prognostic Utility of Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers (Basel). 2021 Aug 19;13(16):4166. doi: 10.3390/cancers13164166. PMID: 34439320; PMCID: PMC8393748.
19. Picarelli H, Yamaki VN, Solla DJF, Neville IS, Santos AGD, Freitas BSAG, Diep C, Paiva WS, Teixeira MJ, Figueiredo EG. The preoperative neutrophil-to-lymphocyte ratio predictive value for survival in patients with brain metastasis. Arq Neurop-siquiatr. 2022 Sep;80(9):922-928. doi: 10.1055/s-0042-1755324. Epub 2022 Oct 4. PMID: 36261127; PMCID: PMC9770070.
20. Hainaut P, Plymouth A. Targeting the hallmarks of cancer: towards a rational approach to next-generation cancer the-rapy. Curr Opin Oncol 2013;25:50–1
21. Sacchetti S, Vidali M, Esposito T, Zorzi S, Burgener A, Ciccarello L, Cammarota G, Zanotti V, Giacomini L, Bellan M, Pirisi M, Lopez RS, Dianzani U, Vaschetto R, Rolla R. The Role of New Morphological Parameters Provided by the BC 6800 Plus Analyzer in the Early Diagnosis of Sepsis. Diagnostics (Basel). 2024 Feb 4;14(3):340. doi: 10.3390/diagnostics14030340. PMID: 38337856; PMCID: PMC10855753.
22. Chun S, Shin K, Kim KH, Kim HY, Eo W, Lee JY, Namkung J, Kwon SH, Koh SB, Kim HB. The Neutrophil-Lymphocyte Ratio Predicts Recurrence of Cervical Intraepithelial Neoplasia. J Cancer. 2017 Jul 15;8(12):2205-2211. doi: 10.7150/jca.19173. PMID: 28819422; PMCID: PMC5560137.
23. Lima PSV, Mantoani PTS, Murta EFC, Nomelini R S. Laboratory parameters as predictors of prognosis in uterine cervical neoplasia. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:391-396. doi: 10.1016/j.ejogrb.2020.11.044. Epub 2020 Nov 19. PMID: 33279808.
24. Mantoani PTS, Vieira JF, Menchete TT, Jammal MP, Michelin MA, Barcelos ACM, Murta EFC, Nomelini RS. CIN Extension at Colposcopy: Relation to Treatment and Blood Parameters. J Obstet Gynaecol Can. 2022 Mar;44(3):255-260. doi: 0.1016/j.jogc.2021.10.008. Epub 2021 Oct 28. PMID: 34718148.
25. Origoni M, Cantatore F, Candotti G, Candiani M. Prognostic Significance of Neutrophil/Lymphocytes Ratio (NLR) in Predic-ting Recurrence of Cervical Dysplasia. Biomed Res Int. 2022 Apr 11;2022:1149789. doi: 10.1155/2022/1149789. PMID: 35445135; PMCID: PMC9015869.
26. 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 Aug 1;20(8):2365-2372. doi: 10.31557/APJCP.2019.20.8.2365. PMID: 31450907; PMCID: PMC6852826.
27. Afşar S, Turan G, Guney G, Sahin G, Talmac MA, Afsar CU. The Relationship between Furin and Chronic Inflammation in the Progression of Cervical Intraepithelial Neoplasia to Cancer: A Cross-Sectional Study. Cancers (Basel). 2023 Oct 7;15(19):4878. doi: 10.3390/cancers15194878. PMID: 37835572; PMCID: PMC10571943.
28. Qin L.The predictive value of NLR, PLR, and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. Discov Oncol. 2024 Mar 31;15(1):91. doi: 10.1007/s12672-024-00956-8. PMID: 38555539; PMCID: PMC10982248.
29. Rajakumar HK, Coimbatore Sathyabal V, Thamilarasan T, Balamurugesan P, Ganesan G. Assessing the use of the triglyceri-de-glycemic index (TyG), neutrophil-lymphocyte Ratio (NLR), and platelet-lymphocyte Ratio (PLR) in distinguishing benign and malignant tumors among patients with complaints of breast mass. Heliyon. 2024 Apr 26;10(9):e30321. doi: 10.1016/j.heliyon.2024.e30321. PMID: 38707333; PMCID: PMC11068809.
30. Karateke A, Kaplanoglu M, Baloglu A. Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer. Asian Pac J Cancer Prev. 2015;16(12):4905-8. doi: 10.7314/apjcp.2015.16.12.4905. PMID: 26163613
31. Staniewska E, Grudzien K, Stankiewicz M, Raczek-Zwierzycka K, Rembak-Szynkiewicz J, Nowicka Z, Tarnawski R, Miszczyk M. The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Pati-ents with Cervical Cancer Treated Using Radiotherapy. Cancers (Basel). 2024 Apr 18;16(8):1542. doi: 10.3390/cancers16081542. PMID: 38672624; PMCID: PMC11049631.