Cervical Conization and Systemic Inflammatory Markers: The Predictive Value of Neutrophil Percentage to Albumin Ratio (NPAR) to Identify High-Grade Cervical Intraepithelial Neoplasia (CIN)

Sıtkı Özbilgeç,1 Fatih Akkuş2 1Department of Obstetrics and Gynecology, Gynecologic Oncology Clinic, Konya City Hospital, Konya, Turkey; 2Department of Obstetrics and Gynecology, Perinatology Clinic, Kütahya City Hospital, Kütahya, TurkeyCorrespondence: Sıtkı Özbilgeç, Konya City Hospital, Konya, Turkey, Email [email protected]: This study aimed to evaluate the predictive value of systemic inflammatory markers, particularly the Neutrophil Percentage to Albumin Ratio (NPAR), in identifying high-grade cervical intraepithelial neoplasia (CIN) in patients undergoing colposcopy and cervical conization.Materials and Methods: A retrospective analysis was conducted on 116 patients who underwent cervical conization between January 2020 and May 2024. Demographic, clinical, and laboratory data were collected, and inflammatory indices, including NPAR, NLR (Neutrophil-to-Lymphocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio), and SII (Systemic Immune-Inflammation Index), were calculated. Sample size estimation was based on prior studies assessing inflammatory markers in CIN, ensuring adequate statistical power for detecting differences in biomarker levels. ROC curve analysis was performed to assess the diagnostic accuracy of these markers.Results: NPAR demonstrated the highest predictive value for high-grade CIN, with an AUC of 0.893. Significant correlations were found between NPAR and other systemic inflammatory markers, such as NLR and SII. However, NLR and PLR showed lower predictive accuracy compared to NPAR.Conclusion: NPAR is a valuable biomarker for predicting high-grade CIN and can aid in patient stratification and treatment planning. Integrating NPAR with other systemic markers may enhance the accuracy of clinical decisions. Further studies with larger cohorts are recommended to validate these findings and explore their clinical utility.Keywords: cervical conization, systemic inflammatory markers, neutrophil percentage to albumin ratio, NPAR, cervical intraepithelial neoplasia, CIN, prognostic biomarkers, systemic immune-inflammation index, SII