ETD

• CD4+ T lymphocytes
• CD68+ macrophages
• cervical intraepithelial neoplasia (CIN)
• local immune microenvironment
• neutrophil-to-lymphocyte ratio (NLR)
• systemic inflammation

Background - The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation with well-established prognostic value in oncology. However, its role in risk stratification for cervical intraepithelial neoplasia (CIN) and its relationship with the local immune response have not yet been fully elucidated.
Methods - A prospective study was carried out on 76 patients undergoing cervical conization. The association between NLR and CIN2-3 was assessed, including clinical, cytological, and colposcopic parameters of the abnormal transformation zone (ANTZ). The local immune response was evaluated through the semi-quantitative histological assessment of the inflammatory infiltrate and immunohistochemical analysis of CD4+ and CD68+ cells.
Results - An NLR ≥ 1.8 appeared as an independent risk factor for CIN2–3 (odds ratio [OR] 6.23; p = 0.022), along with HSIL/ASC-H Pap test results (OR 5.31; p = 0.036) and ANTZ G2 (OR 9.33; p = 0.031). Histological analysis provided a significant association between NLR ≥ 1.8 and a reduced degree of inflammatory infiltrate (OR 0.22; p = 0.013) and lower CD4+ expression (β = −14.26; p = 0.016), alongside increased CD68+ expression (β = +5.81; p = 0.003). Moreover, ANTZ G2 was significantly associated with increased CD4+ expression (β = +12.2; p = 0.036).
Conclusions - These findings suggest that NLR may represent not only a biomarker of CIN2–3, but also a correlate of a local immune response skewed toward a pro-tumorigenic microenvironment.