Systemic inflammatory markers do not independently predict positive surgical margins after loop electrosurgical excision procedure in patients with cervical intraepithelial neoplasia grade 3: a single-center retrospective study
This single-center retrospective study of 1,373 CIN3 patients undergoing LEEP demonstrates that while a nomogram incorporating TCT grade, age, BMI, multiple HPV infection, and parity effectively predicts positive surgical margins (AUC 0.80), systemic inflammatory markers such as SIRI and NLR do not serve as independent predictors.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The cervix is the lower part of the uterus that connects to the vagina, and it is the site where a specific type of precancerous change can begin. When cells in this area start to grow abnormally but have not yet become invasive cancer, doctors call this cervical intraepithelial neoplasia. If these changes reach the most severe stage before turning into cancer, they are classified as grade 3. To stop the disease from progressing, surgeons often use a procedure called a loop electrosurgical excision, where a thin wire loop heated by electricity cuts away the affected tissue. The goal is to remove the entire abnormal area in one piece. However, sometimes the cut edges of the removed tissue still contain abnormal cells. When this happens, the surgical margins are considered positive, meaning the lesion might not be fully gone, which increases the risk that the disease will return or persist. Doctors have long searched for clues before surgery that could predict whether these margins will be clear, hoping to tailor the treatment to each patient's specific risk.
In a recent study involving over 1,300 women with this severe precancerous condition, researchers set out to find which preoperative factors could reliably predict whether the surgery would leave behind any abnormal cells. They gathered a wide range of information from patient records, including age, body measurements, the specific types of human papillomavirus present, and the results of standard cell tests. They also looked closely at blood samples taken before the operation, searching for signs of systemic inflammation. Inflammation is the body's natural response to injury or infection, and certain markers in the blood, such as the ratio of different types of white blood cells, have been shown to predict outcomes in various cancers. The team wondered if these same blood markers could signal whether a precancerous lesion would be difficult to remove completely. They used a computer model to sift through all the data, testing which variables actually mattered and which were just noise.
The study, conducted at a single hospital in China, included 1,373 women who underwent the procedure between 2021 and 2025. The researchers divided the group into two sets to build and then test their prediction model. They found that about 9 percent of the women had positive surgical margins, meaning the abnormal cells were still present at the edge of the removed tissue. When they analyzed the data, they discovered that the blood markers for inflammation did not help predict this outcome. Even though some of these markers appeared slightly different between women with clear margins and those with positive ones when looked at alone, they lost all their predictive power once the researchers accounted for other factors like age and the severity of the cell changes. This suggests that the body's general inflammatory state is not a direct driver of whether the surgeon can successfully remove the entire lesion.
Instead, the model identified five specific factors that worked together to estimate the risk. These included the patient's age, her body mass index, whether she had been pregnant multiple times, whether she had multiple types of the virus at once, and the grade of her cell test results. The most significant predictors were the severity of the cell changes seen on the preoperative test and the patient's age. Older women faced a higher risk of positive margins, a finding the authors link to natural changes in the cervix that occur with aging, such as tissue shrinking and the area where the abnormal cells hide moving deeper inside. The researchers built a visual tool, known as a nomogram, which allows a doctor to plug in these five numbers and get a personalized probability of whether the surgery will leave behind any disease. This tool showed strong accuracy when tested on a separate group of patients, correctly distinguishing between those who would have clear margins and those who would not in 80 percent of cases.
The most important takeaway from this work is what it rules out. For years, scientists have explored whether blood tests for inflammation could serve as a quick, easy way to gauge surgical risk in many types of cancer. This study suggests that for this specific precancerous condition, those blood tests do not provide independent value. The risk of leaving abnormal cells behind appears to be driven more by local physical factors, such as where the lesion is located and how much tissue needs to be removed, rather than by the body's overall immune response. While the blood markers might tell a story about the body's general state, they do not seem to tell the story of whether the surgeon can successfully cut out the problem. The findings offer a clearer path forward for doctors, pointing them toward age and cell test results as the most reliable guides for planning surgery, while suggesting that routine blood inflammation tests may not be necessary for this specific decision.
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