Pretreatment leukocytosis is an indicator of poor prognosis in patients with cervical cancer

ObjectivesThe aim of this study was to investigate the prognostic value of pretreatment leukocytosis in patients with cervical cancer in relation to well-established conventional risk factors.MethodsThe baseline characteristics and outcome data from 536 patients treated for cervical cancer between 1996 April to 2007 March were collected and reviewed. Cox proportional hazards regression model was used to identify independent prognostic factors for overall survival. Subsequently, the prognostic significance of pretreatment WBC count was prospectively investigated in 156 patients newly diagnosed cervical cancer from 2007 April to 2010 March.ResultsIn a retrospective analysis, patients with leukocytosis (WBC ≥ 10,000/μl) showed significantly higher treatment failure rate (P < 0.0001) and shorter OS (P < 0.0001) than the patients without leukocytosis. Tumors from patients with leukocytosis showed significantly stronger immunoreactivity for G-CSF than those obtained from patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, histology, and elevated WBC count (≥ 10,000/μl) were significant prognostic factors in terms of overall survival. In a prospective investigation, patients with leukocytosis showed significantly higher treatment failure rate (P < 0.0001), shorter PFS (P < 0.0001), and higher serum G-CSF concentrations (p = 0.001) than the patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, and elevated WBC count were significant prognostic factors in terms of PFS.ConclusionPretreatment leukocytosis is an independent prognostic factor in patients with cervical cancer. Our finding can be used to identify patients with poor prognosis and to design future tailored clinical trials.

Research highlights
► Pretreatment leukocytosis is an indicator of poor prognosis in cervical cancer.
► Pretreatment neutrophilia is also an indicator of poor prognosis in cervical cancer.
► G-CSF produced by cancer cells is responsible for the leukocytosis and neutrophilia.