Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker in Cervical Cancer: A Literature Review of Current Evidence

Salsabila Ariefani, Putri Rahmadhanita, Floera Finalita

Abstract


Background: The neutrophil-to-lymphocyte ratio (NLR) is a simple systemic inflammatory marker that reflects the balance between pro-tumor inflammation and anti-tumor immunity. Previous studies have shown that a high pre-treatment NLR is associated with poor survival outcomes and advanced clinical stage in cervical cancer. Objective: This review aims to evaluate the prognostic role of NLR and its impact on patient survival. Methods: A literature search was conducted for studies published between 2021-2026 using the PubMed/ MEDLINE database with predefined inclusion and exclusion criteria. A total of eight relevant articles were included in this review. Results: The included studies consistently demonstrated that a high pre-treatment NLR is an independent predictor of poor survival in patients with cervical cancer. Conclusion: NLR appears to be a promising prognostic biomarker for cervical cancer; however, the lack of standardized cut-off values limits its current clinical application.

Full Text:

PDF

References


1. Seb B, Vida B, Keszthelyi E, et al. The Neutrophil-to-Lymphocyte Ratio ( NLR ) as a Potential Predictor in Conization Outcomes for Cervical Cancer. Published online 2025:1-16.

2. 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. 2017;8(8):13400-13412.

3. Zhao M, Gao Z, Wang S, Fu J. Predictive significance of lymphocyte level and neutrophil- ­ lymphocyte ratio values during radiotherapy in cervical cancer treatment. 2023;(June):15820-15830. doi:10.1002/cam4.6221

4. Huang Q, Man Q, Hu J, Yang Y, Zhang Y, Wang W. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer : A systematic review and meta-analysis of observational studies. 2017;8(10):16755-16764.

5. Cupp MA, Cariolou M, Tzoulaki I, Aune D, Evangelou E, Berlanga-taylor AJ. Neutrophil to lymphocyte ratio and cancer prognosis : an umbrella review of systematic reviews and meta-analyses of observational studies. Published online 2020:1-16.

6. Lee JW, Seol KH. Pretreatment Neutrophil-to-Lymphocyte Ratio Combined with Platelet-to-Lymphocyte Ratio as a Predictor of Survival Outcomes after Definitive Concurrent Chemoradiotherapy for Cervical Cancer. Published online 2021.

7. Seb B, Tóth Z, Lotti L, et al. Neutrophil / Lymphocyte Ratio ( NLR ) as a Predictive Marker for p16 Positivity and Cervical Cancer Progression : Insights from the SCOPE Study. Published online 2025.

8. Zhuang X, Li Y, Zheng H, Fu L. Evaluating the prognostic relevance of neutrophil-to- lymphocyte ratio in cervical cancer : a systematic review and meta-analysis. 2024;(December). doi:10.3389/fonc.2024.1461175

9. Sinaga RA, Kurniadi A. Neutrophil-lymphocyte Ration Difference in Squamous Cell Carcinoma and Adenocarcinoma of Cervical Cancer Perbedaan Rasio Neutrofil Limfosit pada Kanker Serviks Tipe Karsinoma Sel Skuamosa dan Tipe Adenokarsinoma. Published online 2022:391-396.

10. Xu L, Song J. Elevated neutrophil – lymphocyte ratio can be a biomarker for predicting the development of cervical intraepithelial neoplasia. :1-5.

11. Study AC, Afsar S, Turan G, Guney G, Sahin G, Talmac MA. The Relationship between Furin and Chronic Inflammation in the Progression of Cervical Intraepithelial Neoplasia to Cancer : Published online 2023.

12. Li Y, Wang X, Li Y, et al. The Combined Prognostic Value of 18 F- ­ FDG PET / CT Metabolic Parameters of Immune Organs and Hematological Immune- ­ Related Markers in Patients With Locally Advanced Cervical Cancer. Published online 2025. doi:10.1002/cam4.70650

13. Polho GB, Murazawa LK, Oliveira VV, et al. Neutrophil-to-lymphocyte ratio predicts long-term survival in early triple negative breast cancer treated with neoadjuvant chemotherapy. Published online 2025:1-11.

14. Yu J, Huang L, Dong T, Cao L. Prediction of outcomes after chemoradiotherapy for cervical cancer by neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. J Obstet Gynaecol (Lahore). 2024;44(1). doi:10.1080/01443615.2024.2361858

15. Teketelew BB, Berta DM, Chane E, et al. Diagnostic accuracy of neutrophil-to- lymphocyte and platelet-to-lymphocyte ratios in differentiating thyroid tumors : A systematic review and meta-analysis. Published online 2025:1-18. doi:10.1371/journal.pone.0322382

16. Seb B. The Lymphocyte-to-Monocyte Ratio ( LMR ) as a Novel Biomarker for Cervical Cancer Risk Stratification in Conization Patients. Published online 2025:1-17.

17. Buonacera A, Stancanelli B, Colaci M. Neutrophil to Lymphocyte Ratio : An Emerging Marker of the Relationships between the Immune System and Diseases. Published online 2022.

18. Maughan TS. The prognostic utility of pre- ­ treatment neutrophil- ­ ratio ( NLR ) in colorectal cancer : A systematic review and meta- ­ analysis. 2021;(June):5983-5997. doi:10.1002/cam4.4143

19. Obeagu EI. Integrating neutrophil-to-lymphocyte ratio into cervical cancer management : implications for prognostic assessment and therapeutic strategies – a narrative review. :7406-7412.




DOI: https://doi.org/10.18860/jim.v10i1.41541

Refbacks

  • There are currently no refbacks.


 

Editorial Office:

Faculty of Medical and Health Science
Universitas Islam Negeri Maulana Malik Ibrahim Malang
Campus 3, Jl. Locari, Tlekung, Batu City
e-mail: medicaljournal@uin-malang.ac.id

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.