Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study
Introduction: The gold standard in the management of locally advanced cervical cancer is definitive chemoradiation followed by brachytherapy. Nonetheless, the interdependence of radiation response and immune balance in cancers is debatable. Inflammation markers such as C-Reactive Protein (CRP) and P...
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JCDR Research and Publications Private Limited
2025-07-01
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| author | Muniba Alim Shamila Alim Shahid Siddiqui Md Asif Khan |
| author_facet | Muniba Alim Shamila Alim Shahid Siddiqui Md Asif Khan |
| author_sort | Muniba Alim |
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| description | Introduction: The gold standard in the management of locally advanced cervical cancer is definitive chemoradiation followed by brachytherapy. Nonetheless, the interdependence of radiation response and immune balance in cancers is debatable. Inflammation markers such as C-Reactive Protein (CRP) and Pro-B-type Natriuretic Peptide (Pro-BNP) have established prognostic value in cancers, but the Neutrophil-Lymphocyte Ratio (NLR) is gaining prominence due to its easy accessibility and strong predictive role in malignancies such as lung, pancreatic and gastric cancers.
Aim: To study NLR as a predictor of clinical response to radiation in cervical cancer.
Materials and Methods: This cohort study assessed 60 women from a tertiary cancer hospital in Western Uttar Pradesh, catering to many districts in North India, between August 2017 and July 2019. The routine blood investigations during assessment at baseline and NLR were obtained. Pelvic chemoradiation of 50 Gy in 25 fractions was administered over 5 weeks with weekly concomitant cisplatin at 35 mg/m². Tumour response was evaluated and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 to find the association between NLR and Complete Response (CR).
Results: Clinical CR was noted in 44 (73.3%) of participants. In the CR group, 10 (22.7%) had baseline haemoglobin levels below 13 g/dL compared to 13 (81.25%) in the Partial Response (PR) group. The majority of patients (39/44) with CRs were noted at NLR levels below 2.9. When the NLR (cut-off 2.9) and response (Complete and PR; CR and PR) were evaluated, the p-value was reported as 0.06, which, although not statistically significant, is encouraging for further investigation towards consensus.
Conclusion: These observations suggest that inflammation appreciably influences the intrinsic tumour characteristics in patients with cervical cancer. Hence, the utility of NLR as a marker to categorise the risk of recurrence in patients with cervical cancer presents an intriguing concern for the future. |
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| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-ec7cf9d166a94e3fb4f8722236cb3e7e2025-07-24T09:52:45ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-07-01197XC13XC1610.7860/JCDR/2025/78703.21271Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort StudyMuniba Alim0Shamila Alim1Shahid Siddiqui2Md Asif Khan3Assistant Professor, Department of Paediatrics, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.Radiation Oncologist, Department of Radiation Oncology, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India.Radiation Oncologist, Department of Radiation Oncology, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India.Senior Resident, Department of Pathology, AIIMS, Gorakhpur, Uttar Pradesh, India.Introduction: The gold standard in the management of locally advanced cervical cancer is definitive chemoradiation followed by brachytherapy. Nonetheless, the interdependence of radiation response and immune balance in cancers is debatable. Inflammation markers such as C-Reactive Protein (CRP) and Pro-B-type Natriuretic Peptide (Pro-BNP) have established prognostic value in cancers, but the Neutrophil-Lymphocyte Ratio (NLR) is gaining prominence due to its easy accessibility and strong predictive role in malignancies such as lung, pancreatic and gastric cancers. Aim: To study NLR as a predictor of clinical response to radiation in cervical cancer. Materials and Methods: This cohort study assessed 60 women from a tertiary cancer hospital in Western Uttar Pradesh, catering to many districts in North India, between August 2017 and July 2019. The routine blood investigations during assessment at baseline and NLR were obtained. Pelvic chemoradiation of 50 Gy in 25 fractions was administered over 5 weeks with weekly concomitant cisplatin at 35 mg/m². Tumour response was evaluated and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 to find the association between NLR and Complete Response (CR). Results: Clinical CR was noted in 44 (73.3%) of participants. In the CR group, 10 (22.7%) had baseline haemoglobin levels below 13 g/dL compared to 13 (81.25%) in the Partial Response (PR) group. The majority of patients (39/44) with CRs were noted at NLR levels below 2.9. When the NLR (cut-off 2.9) and response (Complete and PR; CR and PR) were evaluated, the p-value was reported as 0.06, which, although not statistically significant, is encouraging for further investigation towards consensus. Conclusion: These observations suggest that inflammation appreciably influences the intrinsic tumour characteristics in patients with cervical cancer. Hence, the utility of NLR as a marker to categorise the risk of recurrence in patients with cervical cancer presents an intriguing concern for the future.https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=July&volume=19&issue=7&page=XC13-XC16&id=21271cervical cancerchemoradiationnorth indiapredictive value |
| spellingShingle | Muniba Alim Shamila Alim Shahid Siddiqui Md Asif Khan Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study Journal of Clinical and Diagnostic Research cervical cancer chemoradiation north india predictive value |
| title | Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study |
| title_full | Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study |
| title_fullStr | Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study |
| title_full_unstemmed | Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study |
| title_short | Investigating the Predictive Value of Neutrophil to Lymphocyte Ratio on Radiation Therapy Outcomes: A Cohort Study |
| title_sort | investigating the predictive value of neutrophil to lymphocyte ratio on radiation therapy outcomes a cohort study |
| topic | cervical cancer chemoradiation north india predictive value |
| url | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=July&volume=19&issue=7&page=XC13-XC16&id=21271 |
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