# NGAL and HPV Subtypes in Cervical Carcinoma: Implications for Cancer Progression and Treatment Response

## TL;DR

This study explores the role of NGAL as a potential biomarker in cervical cancer, finding it may reflect tumor inflammation rather than HPV subtype, with possible implications for prognosis.

## Contribution

The study evaluates NGAL levels in cervical cancer patients in relation to HPV subtypes and treatment response, revealing its potential as a tumor-associated inflammation marker.

## Key findings

- NGAL levels increased in inoperable patients and advanced FIGO stages, suggesting potential prognostic value.
- No significant association was found between NGAL levels and HPV subtypes.
- HPV 16 was the most common subtype, and midlife women showed the highest HPV positivity rate.

## Abstract

Background/Objectives: Cervical cancer is a prominent source of morbidity and mortality among women, particularly in low- and middle-income nations. Neutrophil Gelatinase-Associated Lipocalin (NGAL), a glycoprotein involved in cancer-related activities, has been proposed as a biomarker; however, its involvement in cervical cancer remains unknown. The study aim is to evaluate the prognostic significance of serum NGAL levels in cervical cancer patients in relation to International Federation of Gynecology and Obstetrics (FIGO) stage, operability, and HPV subtype distribution before and after treatment. Methods: The study involved 130 women, 100 with histologically proven cervical cancer and 30 healthy controls. The serum NGAL levels were determined before and after treatment using an ELISA test. HPV genotyping was carried out using real-time PCR on 21 high- and low-risk subtypes. Results: NGAL levels increased marginally during therapy (from 134 to 144 ng/mL; p = 0.28), but the rise was significant in inoperable patients (p = 0.02) and increased with advanced FIGO stage, although this did not reach statistical significance (p = 0.07). HPV 16 was the most common subtype (26.0%), while women aged 51–60 had the highest overall HPV positive rate (72.7%). There was no significant association between NGAL levels and HPV subtypes (p = 0.17). Conclusion: NGAL does not appear to be an accurate short-term indicator of therapy response. However, increased levels in advanced-stage and inoperable instances indicate prognostic significance. NGAL most likely represents tumor-associated inflammation rather than HPV subtype. These findings support its possible inclusion in future biomarker panels, subject to validation in bigger investigations. Persistent HPV infection in midlife women highlights the significance of ongoing screening.