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Original Research

Open Access

Pretreatment anemia status and elevated PLR affect the prognosis of locally advanced cervical squamous cell carcinoma patients treated with concurrent chemoradiotherapy

  • Meilian Dong1
  • Yonggang Shi1,*,

1Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China

DOI: 10.22514/ejgo.2022.005 Vol.43,Issue 3,June 2022 pp.103-110

Submitted: 18 February 2022 Accepted: 22 March 2022

Published: 15 June 2022

*Corresponding Author(s): Yonggang Shi E-mail:


Objective: To assess the prognostic value of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in locally advanced cervical squamous cell carcinoma (LACSC) treated with concurrent chemoradiotherapy (CCRT) regimens. Methods: The contribution of systemic immune inflammatory response markers (NLR, PLR, LMR, SII), inflammatory cells (lymphocytes, neutrophils, monocytes, platelets), and hematocrit in predicting the outcomes of concurrent chemoradiotherapy treatment in LACSC patients was examined using the Kaplan-Meier univariate survival analysis method. Variables that were significant for the univariate analysis were included in the multivariate regression analysis to confirm the independent prognostic factors affecting concurrent chemoradiotherapy in LACSC patients. Results: Univariate analysis showed that age (p = 0.024), PLR (p = 0.007), NLR (p = 0.089), LMR (p = 0.021), SII (p = 0.087), and Hb (p = 0.004) were all prognostic factors affecting OS (over survival). Multivariate regression analysis revealed that PLR (p = 0.066) and Hb (p = 0.045) before concurrent chemoradiotherapy were independent risk factors of OS in the studied population. Moreover, these two factors were significantly correlated (correlation coefficient Rs = –0.426, p = 0.000). Conclusions: The results suggested that elevated PLR and anaemia are likely to have poorer prognoses in LACSC patients who initially received radical CCRT. Moreover, pre-treatment anemia status may exacerbate the prognostic effects of PLR.


Locally advanced cervical cancer; Concurrent chemoradiotherapy; Prognosis; Systemic immune inflammatory index; Anemia

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Meilian Dong,Yonggang Shi. Pretreatment anemia status and elevated PLR affect the prognosis of locally advanced cervical squamous cell carcinoma patients treated with concurrent chemoradiotherapy. European Journal of Gynaecological Oncology. 2022. 43(3);103-110.


[1] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; 68: 394–424.

[2] Zhu J, Wu XH. Review of advances in cervical cancer research in 2019. Journal of Multidisciplinary Cancer Management (Electronic Version). 2020; 6 (In Chinese).

[3] Henley SJ, Thomas CC, Lewis DR, Ward EM, Islami F, Wu M, et al. Annual report to the nation on the status of cancer, part II: Progress toward Healthy People 2020 objectives for 4 common cancers. Cancer. 2020; 126: 2250–2266.

[4] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA: A Cancer Journal for Clinicians. 2020; 70: 7–30.

[5] Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. The Lancet. 2019; 393: 169–182.

[6] Liontos M, Kyriazoglou A, Dimitriadis I, Dimopoulos M, Bamias A. Systemic therapy in cervical cancer: 30 years in review. Critical Reviews in Oncology/Hematology. 2019; 137: 9–17.

[7] 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–iv83.

[8] Sasano T, Mabuchi S, Kozasa K, Kuroda H, Kawano M, Takahashi R, et al. The Highly Metastatic Nature of Uterine Cervical/Endometrial Cancer Displaying Tumor-Related Leukocytosis: Clinical and Preclinical Investigations. Clinical Cancer Research. 2018; 24: 4018–4029.

[9] Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, et al. Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer. Scientific Reports. 2019; 9: 3284.

[10] Verma J, Monk BJ, Wolfson AH. New Strategies for Multimodality Therapy in Treating Locally Advanced Cervix Cancer. Seminars in Radiation Oncology. 2016; 26: 344–348.

[11] Porta C, Riboldi E, Sica A. Mechanisms linking pathogens-associated inflammation and cancer. Cancer Letters. 2011; 305: 250–262.

[12] Hanahan D, Weinberg R. Hallmarks of Cancer: the next Generation. Cell. 2011; 144: 646–674.

[13] Peng D, Zhang C, Gong Y, Hao H, Guan B, Li X, et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Scientific Reports. 2018; 8: 794.

[14] Tesfamariam B. Involvement of platelets in tumor cell metastasis. Pharmacology & Therapeutics. 2016; 157: 112–119.

[15] Zhu X, Song H, Chen Y, Han F, Wang Q, Cui Y. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Blood to Distinguish Lung Cancer Patients from Healthy Subjects. Disease Markers. 2020; 2020: 8844698.

[16] Kim J, Jung EJ, Kim J, Lee HS, Kwag S, Park J, et al. Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis. BMC Cancer. 2020; 20: 1206.

[17] Graziano V, Grassadonia A, Iezzi L, Vici P, Pizzuti L, Barba M, et al. Combination of peripheral neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio is predictive of pathological complete response after neoadjuvant chemotherapy in breast cancer patients. The Breast. 2019; 44: 33–38.

[18] Hu Z, Tan S, Chen S, Qin S, Chen H, Qin S, et al. Diagnostic value of hematological parameters platelet to lymphocyte ratio and hemoglobin to platelet ratio in patients with colon cancer. Clinica Chimica Acta. 2020; 501: 48–52.

[19] Ni L, Tao J, Xu J, Yuan X, Long Y, Yu N, et al. Prognostic values of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in endometrial cancer: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics. 2020; 301: 251–261.

[20] Wang N, Li C, Yang Y, Guan Y, Wang F, Wang Y, et al. The Use of Platelet/Lymphocyte Ratio and Cancer Antigen 125 Combined with Magnetic Resonance Diffusion-Weighted Imaging in Diagnosis of Recurrent Ovarian Cancer and Neuropathic Pain. World Neurosurgery. 2021; 149: 502–510.

[21] Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, et al. Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer. Scientific Reports. 2019; 9: 3284.

[22] Chao B, Ju X, Zhang L, Xu X, Zhao Y. A Novel Prognostic Marker Systemic Inflammation Response Index (SIRI) for Operable Cervical Cancer Patients. Frontiers in Oncology. 2020; 10: 766.

[23] Koulis TA, Kornaga EN, Banerjee R, Phan T, Ghatage P, Magliocco AM, et al. Anemia, leukocytosis and thrombocytosis as prognostic factors in patients with cervical cancer treated with radical chemoradiotherapy: a retrospective cohort study. Clinical and Translational Radiation Oncology. 2017; 4: 51–56.

[24] Franco P, Montagnani F, Arcadipane F, Casadei C, Andrikou K, Martini S, et al. The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer. Radiation Oncology. 2018; 13: 83.

[25] Casadei-Gardini A, Montagnani F, Casadei C, Arcadipane F, Andrikou K, Aloi D, et al. Immune inflammation indicators in anal cancer patients treated with concurrent chemoradiation: training and validation cohort with online calculator (ARC: Anal Cancer Response Classifier). Cancer Management and Research. 2019; 11: 3631–3642.

[26] Ogawa H, Fujibayashi Y, Nishikubo M, Nishioka Y, Tane S, Kitamura Y, et al. Prognostic significance of preoperative haemoglobin a1c level in patients with lung adenocarcinoma. Interactive CardioVascular and Thoracic Surgery. 2021; 33: 534–540.

[27] Yalav O, Topal U, Unal AG, Eray IC. Prognostic significance of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients undergoing curative resection for colorectal cancer. Annali Italiani di Chirurgia. 2021; 92: 283–292.

[28] 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: 3000605211061008.

[29] Gakis G, Todenhöfer T, Stenzl A. The prognostic value of hematological and systemic inflammatory disorders in invasive bladder cancer. Current Opinion in Urology. 2011; 21: 428–433.

[30] Cameron SJ, Mix DS, Ture SK, Schmidt RA, Mohan A, Pariser D, et al. Hypoxia and Ischemia Promote a Maladaptive Platelet Phenotype. Arteriosclerosis, Thrombosis, and Vascular Biology. 2018; 38: 1594–1606.

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