Integrating neutrophil-to-lymphocyte ratio into cervical cancer management: implications for prognostic assessment and therapeutic strategies - a narrative review.

Cervical cancer remains a significant global health burden, particularly in low- and middle-income countries. The neutrophil-to-lymphocyte ratio (NLR), a readily accessible and cost-effective inflammatory marker, has emerged as a potential prognostic indicator in various malignancies, including cervical cancer. This narrative review aims to synthesize current evidence on the clinical relevance of NLR in cervical cancer, elucidate its underlying immunological mechanisms, and explore its implications for prognostic assessment and therapeutic decision-making. Relevant literature was identified through a comprehensive search of databases including PubMed, Scopus, and Web of Science. Emphasis was placed on studies investigating the prognostic value of NLR in cervical cancer patients, as well as those exploring the biological rationale linking inflammation and tumor progression. Elevated NLR is consistently associated with poorer survival outcomes, advanced disease stages, lymph node metastasis, and reduced treatment response in cervical cancer patients. Mechanistically, increased neutrophil counts reflect a pro-tumorigenic inflammatory state driven by cytokines such as IL-6 and VEGF, while decreased lymphocyte levels indicate compromised anti-tumor immunity. Additionally, human papillomavirus oncoproteins E6 and E7 contribute to immune evasion and may indirectly influence NLR levels. NLR holds promise as a prognostic biomarker in cervical cancer. However, significant variability in study design, cut-off values, and confounding factors limits its clinical applicability. Standardization of NLR assessment and further validation through large-scale, prospective studies are needed before routine implementation in clinical practice.