Role of monocyte and lymphocyte counts in prognosis of cervical cancer

Aanchal Jain, Saurabh Bobdey, Jignasa Sathwara, B. Ganesh, Sushma Saoba, Arshi Khan


Background: Inflammation seems to play a very crucial role in the growth and progression of many cancers. It has been reported that a peripheral blood count has been used as a cost-effective and simple parameter of systemic inflammation in critically ill patients. The aim of this study is to investigate whether components of WBC counts can predict the prognosis of patients with cervical cancer.

Methods: Medical records of 549 cervical cancer patients diagnosed between 1 January 2008 to 31 December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards model were applied to evaluate the effect of white blood cell (WBC) counts on overall survival.

Results: The 5-year overall survival of the cohort was found to be 67.7%. On the basis of univariate analysis elevated monocyte count (≥0.515 109/L) and lower lymphocyte count (≤2.075 109/L) were associated with poor overall survival (OS) (p=0.016 and 0.002 respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and lower lymphocyte levels were a significant independent predictors for worse OS (HR = 1.555, 95% CI = 1.125-2.149; P=0.008) and (HR = 1.712, 95% CI = 1.232-2.379; P= 0.001) respectively. The advanced overall stage and treatment were also found to be independent indicators for poor OS.

Conclusions: Pretreatment monocyte and lymphocyte count is an independent predictor of prognosis in cervical cancer patients. Thus it may be a cost effective marker to predict the outcome of cervical cancer patients.


Cervical cancer, Survival, Monocyte, Lymphocyte

Full Text:



Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v 1.0, cancer incidence and mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available at Accessed 3 August 2015.

Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11:165-73.

Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;38:352-7.

Ho CM, Chien TY, Huang SH, Wu CJ, Shih BY, Chang SC. Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoing radical hysterectomy. Gynecol Oncol. 2004;93:458-64.

Hoskin PJ, Rojas AM, Peiris SN, Mullassery V, Chong IY. Pre-treatment haemoglobin and peripheral blood lymphocyte count as independent predictors of outcome in carcinoma of cervix. Clin Oncol (R Coll Radiol). 2014;26:179-84.

Saito K, Tatokoro M, Fujii Y, Iimura Y, Koga F, Kawakami S, et al. Impact of C reactive protein kinetics on survival of patients with metastatic renal cell carcinoma. Eur Urol. 2009;55:1145-53.

Toriola AT, Grankvist K, Agborsangaya CB, Lukanova A, Lehtinen M, Surcel HM. Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudal study. Ann Oncol. 2011;22:1916-21.

Lee YY, Choi CH, Sung CO, Do IG, Huh SJ, Song T, et al. Prognostic value of pre-treatment circulating monocyte count in patients with cervical cancer: Comparison with SCC-Ag level. Gynecologic Oncology. 2012;124:92-7.

Choi CH, Kang H, Kim WY, Kim TJ, Lee JW, Huh SJ, et al. Prognostic value of baseline lymphocyte count in cervical carcinoma treated with concurrent chemoradiation. Int J Radiat Oncol Biol Phys. 2008;71:199-204.

Tsai YD, Wang CP, Chen CY, Lin LW, Hwang TZ, Lu LF, et al. Pretreatment circulating monocyte count associated with poor prognosis in patients with oral cavity cancer. Head Neck. 2014;36:947-53.

Hornychova´ H, Melichar B, Tomsˇova´ M, Mergancova´ J, Urminska´ H, Ryska A et al. Tumor-infiltrating lymphocytes predict response to neoadjuvant chemotherapy in patients with breast carcinoma. Cancer Investigation. 2008;26:1024-31.

Bruckner HW, Lavin PT, Plaxe SC, Storch JA, Livstone EM. Absolute granulocyte, lymphocyte, and moncyte counts. Useful determinants of prognosis for patients with metastatic cancer of the stomach. JAMA. 1982;247:1004-06.

Chew V, Chen J, Lee D, Loh E, Lee J, Lim KH. Chemokine-driven lymphocyte infiltration: an early intra-tumoural event determining long-term survival in resectable hepatocellular carcinoma. Gut. 2012;61:427-38.

Koh YW, Kang HJ, Park C, Yoon DH, Kim S, Suh C et al. The ratio of the absolute lymphocyte count to the absolute monocyte count is associated with prognosis in Hodgkin’s lymphoma: correlation with tumor-associated macrophages. Oncologist. 2012;17:871-80.

Tibaldi C, Vasile E, Bernardini I, Orlandini C, Andreuccetti M, Falcone A. Baseline elevated leukocyte count in peripheral blood is associated with poor survival in patients with advanced non-small cell lung cancer: a prognostic model. J Cancer Res Clin Oncol. 2008;134:1143-9.

Mabuchi S, Matsumoto Y, Isohashi F, Yoshioka Y, Ohashi H, Morii E, et al. Pretreatment leukocytosis is an indicator of poor prognosis in patients with cervical cancer. Gynecologic Oncology. 2011;122:25-32.

Rochet NM, Markovic SN, Porrata LF. The role of complete blood cell count in prognosis-watch this space! Oncology and Hematology Review. 2012;8:76-82.

Stone HB, Peters LJ, Milas L. Effect of host immune capability on radiocurability and subsequent transplantability of a murine fibrosarcoma. J Natl Cancer Inst. 1979;63:1229-35.

Demaria S, Formenti SC. Sensors of ionizing radiation effects on the immunological microenvironment of cancer. Int J Radiat Biol. 2007;83:819-25.

Lorimore SA, Coates PJ, Scobie GE, Milne G, Wright EG. Inflammatory-type responses after exposure to ionizing radiation in vivo: a mechanism for radiation-induced bystander effects? Oncogene. 2001;20:7085-95.

Apetoh L, Ghiringhelli F, Tesniere A, Obeid M, Ortiz C, Criollo A, et al. Toll-like receptor 4-dependent contribution of the immune system to anticancer chemotherapy and radiotherapy. Nat Med. 2007;13:1050-9.

Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149-63.

Lee YY, Choi CH, Kim HJ, Kim TJ, Lee JW, Lee JH, et al. Pretreatment neutrophil: lymphocyte ratio as a prognostic factor in cervical carcinoma. Anticancer research. 2012;32:1555-62.

Sajadieh A, Mouridsen MR, Selmer C, Intzilakis T, Nielsen OW, Haugaard SB. Monocyte number associated with incident cancer and mortality in middle-aged and elderly community-dwelling Danes. Eur J Cancer. 2011;47:2015-22.

Matsuo K, Hom MS, Moeini A, Machida H, Takeshima N, Roman LD, et al. Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer. Gynecologic Oncology. 2015;138:332-8.

Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Tominaga M, et al. Prognostic value of preoperative peripheral blood monocyte count in patients with colorectal liver metastasis after liver resection. J Gastrointest Surg. 2007;11:596-602.

Bishara S, Griffin M, Cargill A, Bali A, Gore ME, Kaye SB, et al. Pre-treatment white blood cell subtypes as prognostic indicators in ovarian cancer, Eur J Obstet Gynecol Reprod Biol. 2008;138:71-5.

Anand M, Chodda SK, Parikh PM, Nadkarni JS. Abnormal levels of pro-inflammatory cytokines in serum and monocyte cultures from patients with chronic myeloid leukemia in different stages, and their role in prognosis. Hematol Oncol. 1998;16:143-54.

Pollard JW. Tumour-educated macrophages promote tumour progression and metastasis. Nat Rev Cancer. 2004;4:71-8.

Hefler L, Tempfer C, Heinze G, Mayerhofer K, Breitenecker G, Leodolter S, et al. Monocyte chemoattractant protein-1 serum levels in ovarian cancer patients. Br J Cancer. 1999;81:855-9.

Dirkx AE, Oude Egbrink MG, Wagstaff J, Griffioen AW. Monocyte/macrophage infiltration in tumors: modulators of angiogenesis. J Leukoc Biol. 2006;80:1183-96.

Siddiqui M, Ristow K, Markovic SN, Witzig TE, Habermann TM, Colgan JP, et al. Absolute lymphocyte count predicts overall survival in follicular lymphomas. Br J Haematol. 2006;134:596-601.

Trédan O, Coquard IR, Chvetzoff G, Rebattu P, Bajard A, Chabaud S, et al. Validation of prognostic scores for survival in cancer patients beyond first-line therapy. BMC Cancer. 2011;11:95.

Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International prognostic factors project on advanced hodgkin’s disease. N Engl J Med. 1998;339:1506-14.

Ding PR, An X, Zhang RX, Fang YJ, Li LR, Chen G, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer. Int J Colorectal Dis. 2010;25:1427-33.

Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer. 2006;6;24-37.

Napankangas UT, Soini Y, Paakko P. High number of tumour-infiltrating lymphocytes is associated with apoptosis in non-small cell lung carcinoma. APMIS. 2001;109:525-32.

Donnem T, Al-Shibli K, Andersen S, Al-Saad S, Busund LT, Bremnes RM. Combination of low vascular endothelial growth factor A (VEGF-A)/VEGF receptor 2 expression and high lymphocyte infiltration is a strong and independent favorable prognostic factor in patients with nonsmall cell lung cancer. Cancer. 2010;116:4318-25.

Hiraoka K, Miyamoto M, Cho Y, Suzuoki M, Oshikiri T, Nakakubo Y, et al. Concurrent infiltration by CD8+ T cells and CD4+ T cells is a favourable prognostic factor in non-small-cell lung carcinoma Br J Cancer. 2006;94:275-80.

Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Cesne AL, Judson I, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009;69:5383-91.