The Neutrophil-to-Lymphocyte Ratio (NLR) as a Potential Predictor in Conization Outcomes for Cervical Cancer

Background: Cervical cancer is a major global health concern, particularly in low-resource settings where access to advanced diagnostics is limited. The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory marker, has shown prognostic significance in various malignancies. However, its role in predicting cervical cancer in patients undergoing conization remains unclear. Objectives: This study evaluated NLR's diagnostic and predictive value in identifying malignancy in conization outcomes. Methods: This retrospective study analyzed 374 patients from the SCOPE study. Preoperative NLR levels were assessed with conization histopathology outcomes using the Kruskal-Wallis test, Mann-Whitney U test, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: NLR levels were significantly higher in patients with malignant conization outcomes (χ² = 15.988, p = 0.001). A cut-off NLR ≥ 2.86 significantly predicted cervical cancer presence (p = 0.045). Logistic regression showed that each unit increase in the NLR increased cancer likelihood by 37.2% (p = 0.008). ROC analysis demonstrated moderate diagnostic accuracy (AUC = 0.734), with an optimal NLR cut-off of ≥1.865 yielding 87.0% sensitivity and 53.8% specificity. Conclusions: Our findings suggest that the NLR may serve as a promising, easily accessible, non-invasive biomarker with modest predictive value for cervical cancer in patients undergoing conization. Future studies should focus on validating the NLR in combination with other biomarkers, such as HPV genotyping and molecular markers, to improve diagnostic accuracy, particularly in low-resource settings.