Abstract
ObjectiveWe aimed to demonstrate the clinical and prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in high-grade serous ovarian cancer (HGSC).MethodsWe retrospectively investigated 875 patients who underwent primary staging or debulking surgery for HGSC between April 2005 and June 2013 at our institution. None of these patients received neoadjuvant chemotherapy. NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count. Progression-free survival (PFS) and overall survival (OS) were analyzed with the Kaplan-Meier method and log-rank tests for univariate analyses. For multivariate analyses, Cox regression analysis was used to evaluate the effects of the prognostic factors, which were expressed as hazard ratios (HRs).ResultsThe NLRs ranged from 0.30 to 24.0. The median value was 3.24 and used as the cutoff value to discriminate between the high-NLR (≥3.24) and low-NLR (<3.24) groups. A high preoperative NLR level was associated with an advanced FIGO stage, increased CA125 level, more extensive ascites, worse cytoreduction outcome and chemoresistance. For univariate analyses, a high NLR was associated with reduced PFS (p<0.001) and OS (p<0.001). In multivariate analyses, a high NLR was still an independent predictor of PFS (p = 0.011), but not OS (p = 0.148).ConclusionOur study demonstrated that NLR could reflect tumor burden and clinical outcomes to a certain extent and should be regarded as a predictive and prognostic parameter for HGSC.
Highlights
Ovarian cancer is one of the most commonly diagnosed and lethal diseases among females, and there were 238,700 estimated new cases and 151,900 deaths in 2012 around the world[1]
A high neutrophil-to-lymphocyte ratio (NLR) was associated with reduced Progression-free survival (PFS) (p
Our study demonstrated that NLR could reflect tumor burden and clinical outcomes to a certain extent and should be regarded as a predictive and prognostic parameter for high-grade serous ovarian cancer (HGSC)
Summary
Ovarian cancer is one of the most commonly diagnosed and lethal diseases among females, and there were 238,700 estimated new cases and 151,900 deaths in 2012 around the world[1]. Effective biomarkers for individualized prediction of treatment outcomes and prognosis are urgently required. Inflammation plays an important role during cancer initiation and progression, and the prognostic value of systemic inflammatory response (SIR) markers has been of paramount interest[3]. The neutrophil-to-lymphocyte ratio (NLR), one of the most common SIR markers, has been used to predict clinical outcomes and prognoses in various cancers[4,5,6,7]. Ovarian cancer is not a single disease, it is a group of heterogeneous tumors based on distinctive morphologic and molecular genetic features[11]. Previous studies have combined all disease subtypes within small sample sizes, which failed to individually evaluate the clinical and prognostic values of NLR according to the histologic types
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