Neutrophil/lymphocyte ratio and other blood cell component counts are not associated with the development of postmolar gestational trophoblastic neoplasia

Antonio Braga; Ana Clara Canelas; Berenice Torres; Izildinha Maesta; Luana Giongo Pedrotti; Marina Bessel; Ana Paula Vieira Dos Santos Esteves; Joffre Amim Junior; Jorge Rezende Filho; Kevin M Elias; Neil S Horowitz; Ross S Berkowitz

doi:10.1371/journal.pone.0277892

Neutrophil/lymphocyte ratio and other blood cell component counts are not associated with the development of postmolar gestational trophoblastic neoplasia

PLoS One. 2022 Dec 1;17(12):e0277892. doi: 10.1371/journal.pone.0277892. eCollection 2022.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Rio de Janeiro, Brazil.
² Department of Maternal Child Health, Postgraduate Program in Medical Sciences, Faculty of Medicine of Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
³ National Academy of Medicine, Young Leadership Physicians Program, Rio de Janeiro, Rio de Janeiro, Brazil.
⁴ Postgraduate Program in Applied Health Sciences, Vassouras University, Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Department of Gynecology and Obstetrics, Botucatu Trophoblastic Disease Center of the Clinical Hospital of Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil.
⁶ Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.
⁷ Department of Obstetrics, Gynecology and Reproductive Biology, New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.

Abstract

Objective: To relate preevacuation platelet count and leukogram findings, especially neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios with the occurrence of gestational trophoblastic neoplasia (GTN) after complete hydatidiform mole (CHM) among Brazilian women.

Methods: Retrospective cohort study of patients with CHM followed at Rio de Janeiro Federal University, from January/2015-December/2020. Before molar evacuation, all patients underwent a medical evaluation, complete blood count and hCG measurement, in addition to other routine preoperative tests. The primary outcome was the occurrence of postmolar GTN.

Results: From 827 cases of CHM treated initially at the Reference Center, 696 (84.15%) had spontaneous remission and 131 (15.85%) developed postmolar GTN. Using optimal cut-offs from receiver operating characteristic curves and multivariable logistic regression adjusted for the possible confounding variables of age and preevacuation hCG level (already known to be associated with the development of GTN) we found that ≥2 medical complications at presentation (aOR: 1.96, CI 95%: 1.29-2.98, p<0.001) and preevacuation hCG ≥100,000 IU/L (aOR: 2.16, CI 95%: 1.32-3.52, p<0.001) were significantly associated with postmolar GTN after CHM. However, no blood count profile findings were able to predict progression from CHM to GTN.

Conclusion: Although blood count is a widely available test, being a low-cost test and mandatory before molar evacuation, and prognostic for outcome in other neoplasms, its findings were not able to predict the occurrence of GTN after CHM. In contrast, the occurrence of medical complications at presentation and higher preevacuation hCG levels were significantly associated with postmolar GTN and may be useful to guide individualized clinical decisions in post-molar follow-up and treatment of these patients.

Copyright: © 2022 Braga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Cell Count
Brazil
Cellular Structures
Female
Gestational Trophoblastic Disease*
Humans
Lymphocytes
Neutrophils*
Pregnancy
Retrospective Studies

Grants and funding

This research was supported by the National Council for Scientific and Technological Development – CNPq (AB: 311862/2020-9), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro – FAPERJ (AB: E-26/201.166/2022), Donald P. Goldstein MD Trophoblastic Tumor Registry Endowment (KME, NH, RSB), the Dyett Family Trophoblastic Disease Research and Registry Endowment (KME, NH, RSB) and Keith Higgins and the Andrea S. Higgins Research Fund (KME, NH, RSB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.