Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP

Guanxiang Huang; Hangjing Gao; Yanlin Chen; Wenyu Lin; Jun Shen; Shuxia Xu; Dabin Liu; Zhihui Wu; Xite Lin; Tingting Jiang; Binhua Dong; Pengming Sun

doi:10.2147/JIR.S406082

Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP

J Inflamm Res. 2023 May 1:16:1923-1936. doi: 10.2147/JIR.S406082. eCollection 2023.

Authors

Guanxiang Huang^#^{1

2

3}, Hangjing Gao^#^{1

2

3}, Yanlin Chen^{1

2}, Wenyu Lin^{1

2

3}, Jun Shen⁴, Shuxia Xu⁵, Dabin Liu⁶, Zhihui Wu⁷, Xite Lin^{1

2

3}, Tingting Jiang^{1

2

3}, Binhua Dong^{1

2

3}, Pengming Sun^{1

2

3}

Affiliations

¹ Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.
² Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital (Fujian Women and Children's Hospital), Fuzhou, Fujian, 350001, People's Republic of China.
³ Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital (Fujian Obstetrics and Gynecology Hospital), Fuzhou, Fujian, 350001, People's Republic of China.
⁴ Fujian Provincial Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350001, People's Republic of China.
⁵ Department of Pathology, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350001, People's Republic of China.
⁶ Department of Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350001, People's Republic of China.
⁷ Department of Clinical Laboratory, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350001, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The platelet-to-lymphocyte ratio (PLR) is considered correlated with cancer prognosis including cervical cancer, in addition to high-risk papillomavirus (HR-HPV) infection, of which the predictive value in prognosis of high-grade squamous intraepithelial lesions (HSILs) remains unknown. Here, the prognostic predictive value of PLR in HSIL after loop electrosurgical excision procedure (LEEP) was evaluated.

Patients and methods: This study included 335 nonpregnant participants with histopathologically confirmed HSIL and 3- and 5-year follow-ups from the Fujian Cervical Lesions Screening Cohorts (FCLSCs) between September 2016 and September 2018. PLR and other variables were evaluated to identify the factors related to the recurrence/residual cervical intraepithelial neoplasia (CIN)-free survival (RFS), namely, the time from LEEP at baseline to first detection of recurrence/residual CIN or end of follow-up, by logistic and Cox regression.

Results: In the Kaplan‒Meier analysis, HR-HPV infection (p=0.049/0.012), higher PLR (p=0.031/0.038), and gland invasion (p=0.047) had a higher risk for recurrence/residual CIN at the 3-/5-year follow-up. The univariate logistic and Cox regression analyses showed significant differences and a higher cumulative risk in patients with HR-HPV infection (OR=3.917, p=0.026; HR=3.996, p=0.020) and higher PLR (OR=2.295, p=0.041; HR=2.161, p=0.030) at the 5-year follow-up. The findings by multivariate Cox regression analysis were similar, indicating a poor prognosis for patients with HR-HPV infection (HR=3.901, p=0.023) and higher PLR (HR=2.082, p=0.038) at the 5-year follow-up. The calibration plot showed a better model fit for RFS at the 3-year follow-up.

Conclusion: Preoperative PLR level and HR-HPV infection could be available markers for predicting recurrence/residual disease of HSIL after LEEP. Clinically, combining PLR with HR-HPV tests may provide novel evaluation method and reference for management in post-treatment patients with cervical precancerous lesions.

Keywords: HPV; cervical intraepithelial neoplasia; conization; human papillomavirus; prognosis; systemic inflammatory response.

Grants and funding

This study was supported by grants from the National Key R&D Program of China (grant no. 2021YFC2701205), the National Natural Science Foundation of China (grant no. 82271658), the Fujian Health Young and Middle-aged Scientific Research Major Project (grant no. 2021ZQNZD011), the Fujian Provincial Natural Science Foundation of China (grant no. 2021J01403 and grant no. 2021J01422) and the Fujian Province Science and Technology Innovation Joint Funding Project (grant no. 2021Y9176).