Inflammatory Biomarkers as Promising Predictors of Prognosis in Cervical Cancer Patients

Oncology. 2021;99(9):571-579. doi: 10.1159/000517320. Epub 2021 Jul 15.


Introduction: Increasing evidence demonstrates a crucial role of inflammation in inducing and promoting several cancers. Pro-inflammatory upregulation of cytokines such as IL-6 has been implicated in cervical cancer development and progression through several mechanisms, for example, by inducing platelet production, activation, and aggregation. The aim of the study was to evaluate the effective prognostic impact of inflammatory biomarkers such as platelet count, platelet to lymphocyte ratio (PLR), and IL-6 in cervical cancer patients.

Materials and methods: Between 2016 and 2019, 108 out of 159 patients with cervical cancer have been enrolled. Cutoff level of pretreatment platelet count and PLR was identified by using the ROC curve. IL-6 tumoral and peritumoral expression was analyzed and stratified as low and high (low expression: 0 and +1; marked expression: +2 and +3).

Results: Median follow-up duration was 30 months (range 16-44). Patients with higher platelet counts showed worse DFS and OS (DFS p < 0.001; OS p < 0.001). Cumulative rates of DFS and OS in patients with lower PLR were higher than in patients with higher values of PLR (DFS p = 0.032; OS p < 0.001). Survival analysis showed a better prognosis in patients with lower IL-6 expression (DFS p < 0.001; OS p < 0.001).

Conclusion: Nowadays, causal relationship between inflammation, innate immunity, and cancer is more widely accepted. However, many of the molecular and cellular mechanisms mediating this relationship remain unresolved. Ongoing inflammatory response was associated with poor outcomes in cervical cancer patients. A higher pretreatment platelet count and PLR value associated with higher IL-6 tumoral expression could be used to predict poor prognosis in cervical cancer patients.

Keywords: Biomarkers; Cervical cancer; Immunohistochemistry; Inflammation; Interleukin-6; Platelet to lymphocyte ratio; Prognosis; Thrombocytosis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / metabolism*
  • Female
  • Humans
  • Inflammation Mediators / metabolism*
  • Interleukin-6 / metabolism*
  • Middle Aged
  • Prognosis
  • Survival Analysis
  • Tumor Microenvironment
  • Uterine Cervical Neoplasms / metabolism
  • Uterine Cervical Neoplasms / pathology*
  • Young Adult


  • Biomarkers, Tumor
  • IL6 protein, human
  • Inflammation Mediators
  • Interleukin-6