Hongying Kuang,1,* Dongxia Yang,2,* Ruoyao Lin,3 Yaling Tang,4 Yongli Luo,3 Shuwen Wang,5 Tingting Xia,5 Ge Lou,6 Hong Chen4 

1Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, 150040, People’s Republic of China; 2Department of Gynecology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, 150001, People’s Republic of China; 3Department of Clinical Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, 361005, People’s Republic of China; 4Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, People’s Republic of China; 5Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen, Fujian, 361003, People’s Republic of China; 6Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hong Chen, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, No. 150 Shanggu Street, Siming District, Xiamen, Fujian, 361003, People’s Republic of China, Tel +86 0592213 7307, Email jianguang09@163.com

Background: The rising incidence of cervical cancer among individuals with diabetes is a matter of significant concern, presenting profound implications for the health status and quality of life worldwide. In patients diagnosed with early-stage cervical cancer, the extent of lymph node involvement has emerged as a critical prognostic factor influencing recurrence risk and survival outcomes. Therefore, the precise prediction of pelvic lymph node metastasis is essential for an accurate assessment of prognosis. The preoperative identification of lymph node metastasis constitutes a pivotal element in the formulation of personalized treatment strategies. It has been demonstrated that inflammatory markers such as neutrophils, lymphocytes, and fibrinogen significantly contribute to cancer progression and prognostic evaluations. In this regard, we propose the fibrinogen-to-neutrophil ratio (FNR) as an innovative and promising biomarker for evaluating pelvic lymph node metastasis in cervical cancer patients with type 2 diabetes.
Methods: The study was conducted on 141 patients diagnosed with cervical cancer and concomitant type 2 diabetes, who were treated at the First Affiliated Hospital of Xiamen University. The patients were randomly divided into a training set (n=98) and a validation set (n=43), with a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a prognostic model was established based on these findings. The model’s effectiveness was evaluated.
Results: A nomogram that integrates multiple factors, including FNR, triglycerides, maximum diameter, and total protein, demonstrates superior potential in predicting pelvic lymph node metastasis in patients with type 2 diabetes and cervical cancer, compared to the use of a single biomarker.
Conclusion: As a comprehensive biomarker, FNR shows significant potential in offering a more thorough and reliable approach for identifying cervical cancer patients with diabetes who are at an elevated risk of lymph node metastasis.

Keywords: cervical cancer, diabetes mellitus, pelvic lymph node metastasis, fibrinogen-to-neutrophil ratio, inflammatory biomarkers, preoperative prediction