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.
