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Dynamic Changes in Systemic Inflammatory Indices Predict Residual High-Grade Lesions After Margin-Positive Cervical

Gabriella Vajda1,2, Kornél Lakatos3, Lotti Lőczi1,4

  • 1Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary.

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|April 14, 2026
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Summary

Changes in systemic inflammatory indices like the platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) can help predict residual high-grade cervical lesions after loop electrosurgical excision procedures (LEEP). These markers offer a cost-effective adjunct to HPV testing for risk stratification.

Keywords:
Platelet to Lymphocyte Ratio (PLR)cervical cancerprognostic markerrecognitionsystemic immune inflammation index (SII)systemic inflammation response index (SIRI)

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Area of Science:

  • Oncology
  • Immunology
  • Biomarkers

Background:

  • Cervical cancer is a significant global health issue.
  • Loop electrosurgical excision procedure (LEEP) treats cervical intraepithelial neoplasia, but positive margins necessitate further management.
  • Current post-LEEP surveillance relies on HPV testing, which has limitations in specificity, highlighting the need for additional biomarkers.

Purpose of the Study:

  • To investigate if changes in systemic inflammatory indices predict residual high-grade lesions after incomplete LEEP.
  • To evaluate the predictive value of dynamic changes in platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII).

Main Methods:

  • A multicenter retrospective study of 125 patients undergoing repeat surgery after LEEP due to positive margins.
  • Analysis of preoperative inflammatory index changes (ΔPLR, ΔSIRI, ΔSII) between the first and second procedures.
  • Comparison of index changes with histopathological findings of the second surgery using Mann-Whitney U test and ROC analysis.

Main Results:

  • Significant differences in ΔPLR (p=0.032) and ΔSII (p=0.048) were observed between patients with and without residual high-grade lesions or invasive cancer.
  • ΔSIRI showed borderline significance (p=0.050), but was significantly associated with invasive cancer (p=0.035).
  • Receiver operating characteristic (ROC) analysis indicated modest predictive performance (AUC ≈ 0.60).

Conclusions:

  • Dynamic changes in PLR, SIRI, and SII show potential as inexpensive adjunct biomarkers for risk stratification after incomplete LEEP.
  • These inflammatory indices can complement HPV testing in specific clinical scenarios for improved post-treatment surveillance.
  • Further research may validate these markers for routine clinical use in managing cervical abnormalities.