DOI QR코드

DOI QR Code

Are Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios Associated with Endometrial Precancerous and Cancerous Lesions in Patients with Abnormal Uterine Bleeding?

  • Acmaz, Gokhan (Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital) ;
  • Aksoy, Huseyin (Kayseri Military Hospital) ;
  • Unal, Dilek (Department of Radiation Oncology, Kayseri Education and Research Hospital) ;
  • Ozyurt, Sezin (Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital) ;
  • Cingillioglu, Basak (Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital) ;
  • Aksoy, Ulku (Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital) ;
  • Muderris, Ipek (Department of Obstetrics and Gynecology, Erciyes University Medical School)
  • Published : 2014.02.28

Abstract

Background: An easy, reproducible and simple marker is needed to estimate phase of endometrial pathologic lesions such as hyperplasia and endometrial cancer and distinguish from pathologically normal results. We here aimed to clarify associations among neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. Materials and Methods: Patients (n=161) who were admitted with abnormal uterine bleeding and the presence of endometrial cells on cervical cytology or thick endometrium were investigated. The study constituted of three groups according to pathologic diagnosis. Group 1 included endometrial precancerous lesions like hyperplasia (n=63), group 2 included endometrial cancerous lesions (n=38) and group 3 was a pathologically normal group (n=60). Blood samples were obtained just before the curettage procedure and the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count; similarly, PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Results: The white blood cell count was significantly higher in patients with cancer than in those with hyperplasia (p=0.005). The platelet count and neutrophil to lymphocyte ratio were significantly higher in patients with cancer than in control patients, but there was significantly no difference between patients with hyperplasia and other groups (p=0.001 and p=0.025 respectively). PLR was significantly lower in control subjects than in other groups (p<0.001), but there was no significant difference between patients with hyperplasia and those with cancer. Conclusions: PLR was significantly lower in control subjects than in other groups. Thus both hyperplasia and cancer may be differentiated from pathologically normal patients by using PLR. White blood cell count was significantly higher in patients with cancer than in those with hyperplasia and pathologically normal patients. Therefore white blood cell count may be used for discriminate hyperplasia to cancer. By using multiple inflammation parameters, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients.

Keywords

References

  1. Alexandrakis MG, Passam FH, Moschandrea IA, et al (2003). Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol, 26, 135-40. https://doi.org/10.1097/00000421-200304000-00007
  2. Babu SN, Chetal G, Kumar S (2012). Macrophage migration inhibitory factor: a potential marker for cancer diagnosis and therapy. Asian Pac J Cancer Prev, 13, 1737-44. https://doi.org/10.7314/APJCP.2012.13.5.1737
  3. Choi CH, Kang H, Kim WY, et al (2008). Prognostic value of baseline lymphocyte count in cervical carcinoma treated with concurrent chemoradiation. Int J Radiat Oncol Biol Phys, 71, 199-204. https://doi.org/10.1016/j.ijrobp.2007.09.024
  4. Choi CH, Kim TJ, Lee JW, et al (2006). Phase II study of neoadjuvant chemotherapy with mitomycin-c, vincristine and cisplatin (MVC) in patients with stages IB2-IIB cervical carcinoma. Gynecol Oncol, 104, 64-9.
  5. Fridlender ZG, Sun J, Kim S, et al (2009). Polarization of tumorassociated neutrophil phenotype by TGF$\beta$: "N1" versus "N2" TAN. Cancer Cell, 16, 183-94. https://doi.org/10.1016/j.ccr.2009.06.017
  6. Fukunaga A, Miyamoto M, Cho Y, et al (2004). CD8+ tumorinfiltrating lymphocytes together with CD4+ tumorinfiltrating lymphocytes and dendritic cells improve the prognosis of patients with pancreatic adenocarcinoma. Pancreas, 28, 26-31. https://doi.org/10.1097/00006676-200401000-00023
  7. Guo YZ, Lei Pan, Du CJ, Re DQ, Xie XM (2013). Association between C-reactive protein and risk of cancer: a metaanalysis of prospective cohort studies. Asian Pacific J Cancer Prev, 14, 243-8. https://doi.org/10.7314/APJCP.2013.14.1.243
  8. Heller DS, Mosquera C, Goldsmith LT, Cracchiolo B (2011). Body mass index of patients with endometrial hyperplasia: comparison to patients with proliferative endometrium and abnormal bleeding. J Reprod Med, 56, 110-2.
  9. Kao SC, Pavlakis N, Harvie R, et al (2010). High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res, 16, 5805-13. https://doi.org/10.1158/1078-0432.CCR-10-2245
  10. Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN (2009). Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol, 16, 614-22. https://doi.org/10.1245/s10434-008-0267-6
  11. Kleebkaow P, Maneetab S, Somboonporn W, et al (2008). Preoperative and postoperative agreement of histopathological findings in cases of endometrial hyperplasia. Asian Pac J Cancer Prev, 9, 89-91.
  12. Klinger MH, Jelkmann W (2002). Role of blood platelets in infection and inflammation. J Interferon Cytokine Res, 22, 913-22. https://doi.org/10.1089/10799900260286623
  13. Kusumanto YH, Dam WA, Hospers GA, Meijer C, Mulder NH (2003). Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis, 6, 283-7. https://doi.org/10.1023/B:AGEN.0000029415.62384.ba
  14. Kwon HC, Kim SH, Oh SY, et al (2012). Clinical significance of preoperative neutrophil-lymphocyte versus plateletlymphocyte ratio in patients with operable colorectal cancer. Biomarkers, 17, 216-22. https://doi.org/10.3109/1354750X.2012.656705
  15. Negrier S, Escudier B, Gomez F, et al (2002). Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Francais d' Immunotherapie. Ann Oncol, 13, 1460-8. https://doi.org/10.1093/annonc/mdf257
  16. Saito K, Tatokoro M, Fujii Y, et al (2009). Impact of C-reactive protein kinetics on survival of patients with metastatic renal cell carcinoma. Eur Urol, 55, 1145-53. https://doi.org/10.1016/j.eururo.2008.10.012
  17. Sharaiha RZ, Halazun KJ, Mirza F, et al (2011). Elevated preoperative neutrophil: lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol, 18, 3362-9. https://doi.org/10.1245/s10434-011-1754-8
  18. Smith RA, Bosonnet L, Ghaneh P, et al (2008). The plateletlymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery, 143, 658-66. https://doi.org/10.1016/j.surg.2007.12.014
  19. Tavares-Murta BM, Mendonca MA, Duarte NL, et al (2010). Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer, 20, 1154-9. https://doi.org/10.1111/IGC.0b013e3181ef8deb
  20. Teramukai S, Kitano T, Kishida Y, et al (2009). Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer, 45, 1950-8. https://doi.org/10.1016/j.ejca.2009.01.023
  21. Toriola AT, Grankvist K, Agborsangaya CB, et al (2011). Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudal study. Ann Oncol, 22, 1916-21. https://doi.org/10.1093/annonc/mdq694
  22. Turan T, Karadag B, Karabuk E, et al (2012). Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia. Asian Pac J Cancer Prev, 13, 1953-6. https://doi.org/10.7314/APJCP.2012.13.5.1953
  23. Unal D, Eroglu C, Kurtul N, Oguz A, Tasdemir A (2013). Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non-small cell lung cancer associated with treatment response and prognosis? Asian Pac J Cancer Prev, 14, 5237-42. https://doi.org/10.7314/APJCP.2013.14.9.5237
  24. Wang GY, Yang Y, Li H, et al (2011). A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of hbv-associated hepatocellular carcinoma after liver transplantation. PLoS One, 6, 25295. https://doi.org/10.1371/journal.pone.0025295

Cited by

  1. Predictive Role of the Neutrophil Lymphocyte Ratio for Invasion with Gestational Trophoblastic Disease vol.15, pp.10, 2014, https://doi.org/10.7314/APJCP.2014.15.10.4203
  2. Comparison of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios for Predicting Malignant Potential of Suspicious Ovarian Masses in Gynecology Practice vol.15, pp.15, 2014, https://doi.org/10.7314/APJCP.2014.15.15.6239
  3. Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia vol.15, pp.8, 2014, https://doi.org/10.7314/APJCP.2014.15.8.3737
  4. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with endometrial hyperplasia and endometrial cancer vol.41, pp.3, 2014, https://doi.org/10.1111/jog.12536
  5. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival vol.113, pp.2, 2015, https://doi.org/10.1038/bjc.2015.200
  6. Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer vol.16, pp.12, 2015, https://doi.org/10.7314/APJCP.2015.16.12.4905
  7. Do Leukocyte and Platelet Counts Have Benefit for \Preoperative Evaluation of Endometrial Cancer? vol.16, pp.13, 2015, https://doi.org/10.7314/APJCP.2015.16.13.5305
  8. Platelet Indices May be Useful in Discrimination of Benign and Malign Endometrial Lesions, and Early and Advanced Stage Endometrial Cancer vol.16, pp.13, 2015, https://doi.org/10.7314/APJCP.2015.16.13.5397
  9. Could the Platelet-to-Lymphocyte Ratio be a Novel Marker for Predicting Invasiveness of Cervical Pathologies? vol.16, pp.3, 2015, https://doi.org/10.7314/APJCP.2015.16.3.923
  10. Value of the Platelet to Lymphocyte Ratio in the Diagnosis of Ovarian Neoplasms in Adolescents vol.16, pp.5, 2015, https://doi.org/10.7314/APJCP.2015.16.5.2037
  11. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio vol.18, pp.7, 2015, https://doi.org/10.1111/1756-185X.12582
  12. Pretreatment prognostic nutritional index is a significant predictor of prognosis in patients with cervical cancer treated with concurrent chemoradiotherapy vol.5, pp.5, 2016, https://doi.org/10.3892/mco.2016.1028
  13. Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia vol.65, pp.10, 2016, https://doi.org/10.1007/s00011-016-0960-z
  14. Neutrophil-to-lymphocyte ratio: Prognostic indicator for head and neck squamous cell carcinoma vol.39, pp.4, 2017, https://doi.org/10.1002/hed.24658
  15. Predictive value of some hematological parameters for non-invasive and invasive mole pregnancies vol.31, pp.3, 2018, https://doi.org/10.1080/14767058.2017.1281906
  16. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia vol.58, pp.2, 2015, https://doi.org/10.5468/ogs.2015.58.2.157
  17. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis vol.44, pp.4, 2018, https://doi.org/10.1590/s1677-5538.ibju.2018.0004.0