Correlation Of Haemoglobin, Leukocytes, Platelet And Neutrophil-Lymphocyte Ratio To Radiotherapy Response In Stage IIB-IIIB Cervical Cancer Patients
DOI:
https://doi.org/10.63682/jns.v14i26S.6262Keywords:
cervical cancer, hemoglobin, neutrophil-to-lymphocyte ratio (NLR), platelet, radiotherapy, response evaluation criteria in solid tumor (RECIST), white blood cellsAbstract
Background: Cervical cancer is a common gynaecological cancer, with high prevalence especially in advanced stages. Radiotherapy is one of the main therapies, but the response to radiotherapy is influenced by several factors. Some studies suggest that haemoglobin, leucocyte, platelet, and neutrophil lymphocyte ratio (NLR) levels may play a role as prognostic indicators in the effectiveness of radiotherapy in cervical cancer. This study aims to analyse the relationship of haemoglobin, leucocyte, platelet and NLR levels to radiotherapy response in stage IIB-IIIB cervical cancer patients.
Methods: Analytical observational study with a retrospective cohort approach involving 50 stage IIB-IIIB cervical cancer patients undergoing radiation therapy. Blood profile measurements and radiotherapy response were taken from medical records before and during radiotherapy. Statistical analysis was performed using Chi-square test and logistic regression to determine the relationship between haematological parameters and radiotherapy response.
Results: The Friedman test showed a significant decrease in leukocyte levels during radiotherapy (X²=81.54; p<0.001) and platelet levels (X²=61.50; p<0.001), with a downward trend beginning after the 10th radiation session. However, there were no significant differences between hematological parameters (hemoglobin, leukocytes, platelets, and NLR) and treatment response groups (p>0.05). Log-rank analysis of progression-free survival (PFS) indicated that only leukocyte levels had a significant association. Preradiation leukocyte counts ≥8.85 were associated with a higher risk of disease progression (HR=2.96; 95% CI = 1.26–6.94; p=0.013).
Conclusion: Leukocytes serve as a prognostic factor in determining progressive response.
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Bejar FG, Oaknin A, Williamson C, Mayadev J, Peters PN, Secord AA, et al. Novel therapies in gynecologic cancer. American Society of Clinical Oncology Educational Book. 2022;(42):483–99.
The American Cancer Society. Key Statistics Cervical Cancer. Atlanta: The American Cancer Society; 2022.
Kementerian Kesehatan Republik Indonesia. Pedoman Nasional Pelayanan Kedokteran Kanker Serviks. Jakarta: Kementerian Kesehatan Republik Indonesia; 2017.
Bai Y. Molecular Genetic Pathology Of Solid Tumors: Henry’s Clinical Diagnosis and Management by Laboratory Methods. Elsevier; 2022.
Bermúdez-Guzmán L. Pan-cancer analysis of non-oncogene addiction to DNA repair. Sci Rep. 2021;11(1):23264.
The American Cancer Society. Treating Cervical Cancer. Atlanta: The American Cancer Society; 2021.
Carrero YN, Callejas DE, Mosquera JA. In situ immunopathological events in human cervical intraepithelial neoplasia and cervical cancer: Review. Transl Oncol. 2021;14(5):101058.
Choi N, Kim JH, Chie EK, Gim J, Kang HC. A meta-analysis of the impact of neutrophil-to-lymphocyte ratio on treatment outcomes after radiotherapy for solid tumors. Medicine. 2019;98(18):e15369.
Kim HS, Yoon G, Ryu JY, Cho YJ, Choi JJ, Lee YY, et al. Sphingosine kinase 1 is a reliable prognostic factor and a novel therapeutic target for uterine cervical cancer. Oncotarget. 2015;6(29):26746–56.
Rojas‐Puentes L, Cardona AF, Carranza H, Vargas C, Jaramillo LF, Zea D, et al. Epithelial–mesenchymal transition, proliferation, and angiogenesis in locally advanced cervical cancer treated with chemoradiotherapy. Cancer Med. 2016;5(8):1989–99.
Xie XZ, Song K, Cui B, Jiang J, Zhang YZ, Wang B, et al. Clinical and pathological factors related to the prognosis of chinese patients with stage Ib to IIb cervical cancer. Asian Pacific Journal of Cancer Prevention. 2012;13(11):5505–10.
Yang Y, Song K ling, Chang H, Chen L. Decreased expression of microRNA-126 is associated with poor prognosis in patients with cervical cancer. Diagn Pathol. 2014;9(1):220.
Wu J, Chen M, Liang C, Su W. Prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in cervical cancer: a meta-analysis and systematic review. Oncotarget. 2017;8(8):13400–12.
Li B, Shou Y, Zhu H. Predictive value of hemoglobin, platelets, and D-dimer for the survival of patients with stage IA1 to IIA2 cervical cancer: a retrospective study. Journal of International Medical Research. 2021;49(12).
Allahqoli L, Dehdari T, Rahmani A, Fallahi A, Gharacheh M, Hajinasab N, et al. Delayed cervical cancer diagnosis: a systematic review. Eur Rev Med Pharmacol Sci. 2022;26(22):8467–80.
Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580.
Isabirye A. Individual and intimate-partner factors associated with cervical cancer screening in Central Uganda. PLoS One. 2022;17(9):e0274602.
Tekalegn Y, Sahiledengle B, Woldeyohannes D, Atlaw D, Degno S, Desta F, et al. High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies. Women’s health. 2022;18:1.
Wang M, Huang K, Wong MCS, Huang J, Jin Y, Zheng ZJ. Global cervical cancer incidence by histological subtype and implications for screening methods. J Epidemiol Glob Health. 2024;14(1):94–101.
Ojha N, Jha M, Shrestha E, Dangal G. Late stage cervical cancer among confirmed cervical cancer cases in a tertiary care centre: A descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(239):630–4.
Urbute A, Frederiksen K, Thomsen LT, Kesmodel US, Kjaer SK. Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: A nationwide, population-based cohort study. Gynecol Oncol. 2024;181:20–7.
Liang C, Wang W, Yang G, Xu Z, Li J, Wu K, et al. Utility of interim apparent diffusion coefficient value in predicting treatment response among patients with locally advanced cervical cancer treated with radiotherapy. Clin Transl Radiat Oncol. 2024;48:100827.
Olthof EP, van der Aa MA, Adam JA, Stalpers LJA, Wenzel HHB, van der Velden J, et al. The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases—a literature review. Int J Clin Oncol. 2021;26(9):1600–10.
Zayed S, Nguyen TK, Lin C, Boldt G, Beriwal S, Creutzberg CL, et al. Red blood cell transfusion practices for patients with cervical cancer undergoing radiotherapy. JAMA Netw Open. 2021;4(4):e213531.
Ruchalski K, Anaokar JM, Benz MR, Dewan R, Douek ML, Goldin JG. A call for objectivity: Radiologists’ proposed wishlist for response evaluation in solid tumors (RECIST 1.1). Cancer Imaging. 2024;24(1):154.
Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017;28:iv72–83.
Datta NR, Stutz E, Liu M, Rogers S, Klingbiel D, Siebenhüner A, et al. Concurrent chemoradiotherapy vs . radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis. Gynecol Oncol. 2017;145(2):374–85.
Berta DM, Teketelew BB, Chane E, Bayleyegn B, Tamir M, Cherie N, et al. Hematological changes in women with cervical cancer before and after cancer treatment: Retrospective cohort study. Sci Rep. 2024;14(1):27630.
Jameus A, Kennedy AE, Thome C. Hematological changes following low dose radiation therapy and comparison to current standard of care cancer treatments. Dose Response. 2021;19(4):15593258211056196.
Corbeau A, Kuipers SC, de Boer SM, Horeweg N, Hoogeman MS, Godart J, et al. Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review. Radiotherapy and Oncology. 2021;164:128–37.
Vitzthum LK, Heide ES, Park H, Williamson CW, Sheridan P, Huynh-Le MP, et al. Comparison of hematologic toxicity and bone marrow compensatory response in head and neck vs. cervical cancer patients undergoing chemoradiotherapy. Front Oncol. 2020;10.
Gennigens C, DeCuypere M, Seidel L, Hermesse J, Barbeaux A, Forget F, et al. Correlation between hematological parameters and outcome in patients with locally advanced cervical cancer treated by concomitant chemoradiotherapy. Cancer Med. 2020;9(22):8432–43.
Duskin-Bitan H, Leibner A, Amitai O, Diker-Cohen T, Hirsch D, Benbassat C, et al. Bone-marrow suppression in elderly patients following empiric radioiodine therapy: Real-life data. Thyroid. 2019;29(5):683–91.
Huang J, Gu F, Ji T, Zhao J, Li G. Pelvic bone marrow sparing intensity modulated radiotherapy reduces the incidence of the hematologic toxicity of patients with cervical cancer receiving concurrent chemoradiotherapy: a single-center prospective randomized controlled trial. Radiation Oncology. 2020;15(1):180.
Shimura K, Mabuchi S, Komura N, Yokoi E, Kozasa K, Sasano T, et al. Prognostic significance of bone marrow FDG uptake in patients with gynecological cancer. Sci Rep. 2021;11(1):2257.
Ran Q, Guo C, Sun C, Liu Q, He H, Zhao W, et al. Loss of FGFR3 accelerates bone marrow suppression-induced hematopoietic stem and progenitor cell expansion by activating FGFR1-ELK1-Cyclin D1 signaling. Transplant Cell Ther. 2021;27(1):45.e1-45.e10.
Mitsuhashi N, Ikeda H, Nemoto Y, Kuronuma M, Kamiga M, Hiroshima Y. Hemostatic effect of palliative radiation therapy in preventing blood transfusions from bleeding occurring within advanced gastric cancer. Palliat Med Rep. 2021;2(1):355–64.
Rafieemehr H, Maleki Behzad M, Azandeh S, Farshchi N, Ghasemi Dehcheshmeh M, Saki N. Chemo/radiotherapy-induced bone marrow niche alterations. Cancer Invest. 2020;1–15.
Jia W, Li X, Zhang T, Wang C, Zhen M. Efficiently normalizing leukopoiesis by gadofullerene nanoparticles to ameliorate radiation-triggered myelosuppression. J Mater Chem B. 2023;11(31):7401–9.
Sun S, Chen Z, Li P, Wu J, Zhu B, Zhang X, et al. Clinical study of acute toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy for cervical cancer. Ginekol Pol. 2023;94(2):101–6.
Trindade AJ, Thaniyavarn T, Townsend K, Klasek R, Tsveybel KP, Kennedy JC, et al. Alemtuzumab as a therapy for chronic lung allograft dysfunction in lung transplant recipients with short telomeres. Front Immunol. 2020;11.
Ye X, Zhou J, Guo S, Lou P, Ma R, Guo J. The undervalued acute leukopenia induced by radiotherapy in cervical cancer. Curr Radiopharm. 2023;16(1):50–6.
Wild AT, Herman JM, Dholakia AS, Moningi S, Lu Y, Rosati LM, et al. Lymphocyte-sparing effect of stereotactic body radiation therapy in patients with unresectable pancreatic cancer. International Journal of Radiation Oncology Physics. 2016;94(3):571–9.
Miszczyk M, Majewski W. Hematologic toxicity of conformal radiotherapy and intensity modulated radiotherapy in prostate and bladder cancer patients. Asian Pac J Cancer Prev. 2018;19(10):2803–6.
Swanson GP, Hammonds K, Jhavar S. Reference results for blood parameter changes and recovery after pelvic radiation without chemotherapy. Hematol Rep. 2022;14(2):155–64.
Tang S, Li L, Yuan S. Effects of radiotherapy and chemotherapy on platelet in patients with lung cancer. Frontiers in Bioscience-Landmark. 2023;28(11).
Zheng Z, Su J, Bao X, Wang H, Bian C, Zhao Q, et al. Mechanisms and applications of radiation-induced oxidative stress in regulating cancer immunotherapy. Front Immunol. 2023;14.
DiCarlo AL, Poncz M, Cassatt DR, Shah JR, Czarniecki CW, Maidment BW. Medical countermeasures for platelet regeneration after radiation exposure. Report of a workshop and guided discussion sponsored by the National Institute of Allergy and Infectious Diseases, Bethesda, MD, March 22–23, 2010. Radiat Res. 2011;176(1):e0001-15.
Fan X, Krzyzanski W, Wong RSM, Liu D, Yan X. Novel combination of erythropoietin and romiplostim to treat chemotherapy-induced anemia and thrombocytopenia via pharmacodynamic interaction on hematopoietic stem and progenitor cells. ACS Pharmacol Transl Sci. 2023;6(12):1884–97.
Yi W, Kim BH, Kim M, Ryang SR, Jang MH, Kim JM, et al. Short-term bone marrow suppression in differentiated thyroid cancer patients after radioactive iodine treatment. Endocr J. 2020;67(12):1193–8.
Muhammed AABM, Thakur N, Patel S. Prognostic significance of neutrophil lymphocyte ratio in patients of carcinoma cervix treated with radiotherapy. Oncology Journal of India. 2020;4(3):92.
Kunos CA, Fabian D, Fredericks T, Baldwin L, Dietrich C, Miller RW, et al. Hemoglobin level associates with survival in women from Appalachian Kentucky with uterine cervix cancer. Front Oncol. 2023;13.
Jeong MH, Kim H, Kim TH, Kim MH, Kim BJ, Ryu SY. Prognostic significance of pretreatment lymphocyte percentage and age at diagnosis in patients with locally advanced cervical cancer treated with definite radiotherapy. Obstet Gynecol Sci. 2019;62(1):35.
Chen HH, Meng WY, Li RZ, Wang QY, Wang YW, Pan HD, et al. Potential prognostic factors in progression-free survival for patients with cervical cancer. BMC Cancer. 2021;21(1):531.
Welsh L, Panek R, Riddell A, Wong K, Leach MO, Tavassoli M, et al. Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck. Br J Cancer. 2017;116(1):28–35.
Fachini AMD, Zuliani AC, Sarian LO, Teixeira JC, Esteves SCB, da Costa Machado H, et al. Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: A randomized controlled trial. Gynecol Oncol. 2021;160(2):379–83.
Ayhan S, Akar S, Kar İ, Turan AT, Türkmen O, Kiliç F, et al. Prognostic value of systemic inflammatory response markers in cervical cancer. J Obstet Gynaecol (Lahore). 2022;42(6):2411–9.
Chao B, Ju X, Zhang L, Xu X, Zhao Y. A novel prognostic marker Systemic Inflammation Response Index (SIRI) for operable cervical cancer Patients. Front Oncol. 2020;10.
Wisdom AJ, Hong CS, Lin AJ, Xiang Y, Cooper DE, Zhang J, et al. Neutrophils promote tumor resistance to radiation therapy. Proc Natl Acad Sci U S A. 2019;116(37):18584–9.
Yildirim BA, Guler OC, Kose F, Onal C. The prognostic value of haematologic parameter changes during treatment in cervical cancer patients treated with definitive chemoradiotherapy. J Obstet Gynaecol (Lahore). 2019;39(5):695–701.
Maulard A, Chargari C, Faron M, Alwohaibi A, Leary A, Pautier P, et al. A new score based on biomarker values to predict the prognosis of locally advanced cervical cancer. Gynecol Oncol. 2020;159(2):534–8.
Ferioli M, Benini A, Malizia C, Forlani L, Medici F, Laghi V, et al. Classical prognostic factors predict prognosis better than inflammatory indices in locally advanced cervical cancer: Results of a comprehensive observational study including tumor-, patient-, and treatment-related data (ESTHER Study). J Pers Med. 2023;13(8):1229.
Cao W, Yao X, Cen D, Zhi Y, Zhu N, Xu L. Prognostic role of pretreatment thrombocytosis on survival in patients with cervical cancer: a systematic review and meta-analysis. World J Surg Oncol. 2019;17(1):132.
Li N, Zhang Y, Qu W, Zhang C, Ding Z, Wang L, et al. Analysis of systemic inflammatory and coagulation biomarkers in advanced cervical cancer: Prognostic and predictive significance. Int J Biol Markers. 2023;38(2):133–8.
Ergen S, Barlas C, Dagdelen M, Can G, Sahinler I. The prognostic role of the pretreatment peripheral neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with cervical cancer. Ann Med Res. 2021;28(4):778.
Xu R, Lu H, Guo Q, Qian J, Fan Q, Zhao P, et al. The prognostic value of peripheral inflammatory cell ratios in patients with cervical cancer after radiotherapy. 2021.
Han X, Liu S, Yang G, Hosseinifard H, Imani S, Yang L, et al. Prognostic value of systemic hemato-immunological indices in uterine cervical cancer: A systemic review, meta-analysis, and meta-regression of observational studies. Gynecol Oncol. 2021;160(1):351–60.
Punjabi A, Barrett E, Cheng A, Mulla A, Walls G, Johnston D, et al. Neutrophil–lymphocyte ratio and absolute lymphocyte count as prognostic markers in patients treated with curative-intent radiotherapy for non-small cell lung cancer. Clin Oncol. 2021;33(8):e331–8.
Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Lopez C, et al. Impact of blood transfusions on survival of locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy Plus Radical Surgery. International Journal of Gynecological Cancer. 2017;27(3):514–22.
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