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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Haematology results, inflammatory haematological ratios, and inflammatory indices in cervical cancer: How is the difference between cancer stage?
Phey Liana, Hanif Gusneri Syahbiran, Nurmalia Purnama Sari, Kemas Yakub Rahadiyanto, Raissa Nurwany, Wahyudi Nurhidayat, Tungki Pratama Umar
Phey Liana, Nurmalia Purnama Sari, Department of Clinical Pathology, Faculty of Medicine, Universitas Sriwijaya-Dr. Mohammad Hoesin General Hospital, Palembang 30114, Sumatera Selatan, Indonesia
Hanif Gusneri Syahbiran, Department of Medicine Programme, Faculty of Medicine, Universitas Sriwijaya, Palembang 30114, Sumatera Selatan, Indonesia
Kemas Yakub Rahadiyanto, Department of Clinical Pathology, Faculty of Medicine, Universitas Sriwijaya, Palembang 30114, Sumatera Selatan, Indonesia
Raissa Nurwany, Department of Physiology and Medical Physics, Faculty of Medicine, Universitas Sriwijaya, Palembang 30114, Sumatera Selatan, Indonesia
Wahyudi Nurhidayat, Department of Radiotherapy, Dr. Mohammad Hoesin General Hospital, Palembang 30114, Sumatera Selatan, Indonesia
Tungki Pratama Umar, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London WC1E 6BT, United Kingdom
Author contributions: Liana P and Sari NP conceptualized the study; Liana P and Syahbiran HG performed the research; Liana P, Sari NP, Rahadiyanto KY, Nurwany R, and Umar TP determined the methodology; Liana P, Sari NP, Rahadiyanto KY, Nurwany R, Nurhidayat W, and Umar TP conducted data validation and analysis; Liana P, Syahbiran HG, Sari NP, and Umar TP wrote the manuscript; Liana P and Umar TP revised the manuscript for important intellectual content; and all authors have read and approved the final version of the manuscript.
Institutional review board statement: The study has received approval from the medical and health research ethics committees of the Faculty of Medicine, Universitas Sriwijaya, under Protocol No. 301-2023.
Informed consent statement: No identifiable human data were used for this study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Phey Liana, MBBS, MD, PhD, Associate Professor, Lecturer, Resea
rcher, Department of Clinical Pathology, Faculty of Medicine, Universitas Sriwijaya-Dr. Mohammad Hoesin General Hospital, Dr. Mohammad Ali Street, RSMH Complex Palembang, Indonesia, Palembang 30114, Sumatera Selatan, Indonesia.
pheyliana@fk.unsri.ac.id
Received: May 20, 2024
Revised: October 22, 2024
Accepted: November 1, 2024
Published online: March 20, 2025
Processing time: 219 Days and 17.1 Hours
BACKGROUND
Cervical cancer is a prevalent form of cancer affecting women worldwide and it is the second most common cancer among women in Indonesia, accounting for 8.5% of all cancer-related deaths. Cervical cancer progression can be evaluated through laboratory tests to detect anaemia, an increased platelet count, and elevated inflammatory markers, therefore, effective laboratory examination is crucial for early detection and treatment of cervical cancer.
AIM
To evaluate the association between laboratory findings (haematology, haematology index, and inflammatory index) and the clinical stage of cervical cancer.
METHODS
This cross-sectional study analyzed adult cervical cancer patients’ data from medical records and laboratory results including sociodemographic status, histopathological finding, clinical stage, and complete haematology examination. Numerical data was analyzed by the one-way ANOVA (normal data distribution), while the Kruskal-Wallis test was used for non-parametric data (abnormal distribution), followed by appropriate post-hoc analysis. The categorical data was analyzed by the Chi-square or Fisher Exact tests. The significance level was established at a P value < 0.05.
RESULTS
This study involved the data of 208 adult cervical cancer patients and found no association between age, marital history, parity history, hormonal contraceptive use and cervical cancer stages. There were significant differences in the clinical laboratory test results based on the clinical stage of cervical cancer, including haemoglobin levels (P < 0.001), leucocytes (P < 0.001), neutrophils (P < 0.001), monocytes (P = 0.002), lymphocytes (P = 0.006), platelets (P < 0.001), neutrophil-lymphocyte ratio/NLR (P < 0.001), lymphocyte-monocyte ratio/LMR (P < 0.001), and platelet-lymphocyte ratio/PLR (P < 0.001). There were also significant differences in the systemic inflammatory index (SII) and systematic inflammatory response index (SIRI) between stage III + IV cervical cancer and stage II (SII P < 0.001; SIRI P = 0.001) and stage I (SII P < 0.001; SIRI P = 0.016), associated with the shifts in previously mentioned complete haematological values with cancer advancement.
CONCLUSION
The haematological parameters, inflammatory haematological ratios, and inflammatory indices exhibited significant differences between cervical cancer stages, therefore these tests can be utilized to evaluate cervical cancer progression.
Core Tip: The current investigation of 208 adult cervical patients found that hematologic parameters such as leucocyte, neutrophil, monocyte, and platelet counts vary significantly depending on the cervical cancer clinical stage. There were significant changes in inflammatory haematological ratios (neutrophil-lymphocyte ratio/NLR, platelet-lymphocyte ratio/PLR, and lymphocyte-monocyte ratio/LMR) and inflammatory indices (systemic immune-inflammation index/SII and systemic inflammation response index/SIRI), particularly between patients with stage III + IV and those with stage II and I cervical cancer. The analysis revealed that the cervical cancer clinical stage is highly related to the hematologic parameters.
