Prognostic significance and predictors of the system inflammation score in ovarian clear cell carcinoma.

Hongwei Zhang,Congjian Xu,Jiayi Zhou,Haiou Liu,Yingying Lu,Zehua Wang,Jiaqi Lu,Renato Franco

doi:10.1371/journal.pone.0177520

Hongwei Zhang, Congjian Xu + Show 6 more

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https://doi.org/10.1371/journal.pone.0177520

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Abstract

Chronic inflammation is a well-known epidemiologic factor of ovarian clear cell carcinomas (OCCC), but has an uncertain role in prognosis. We developed a systemic inflammation score (SIS) based on preoperative serum albumin and neutrophil-to-lymphocyte ratio (NLR) for predicting progression-free survival (PFS) and overall survival (OS) in OCCC patients. A retrospective review was performed in 155 patients with OCCC undergoing primary debulking and chemotherapy at a single institute between 1995 and 2010. Cox regression models were fitted to analyze the effect of prognostic factors on PFS and OS. Harrell’s concordance index was calculated to assess predictive accuracy. The SIS consisting of serum albumin and NLR was retained as an independent indicator adjusting for traditional clinicopathological features. A high SIS was significantly associated with aggressive tumor behavior, platinum resistance, and served as an independent predictor of reduced PFS (P = 0.006) and OS (P = 0.019). The SIS had a good discrimination ability for the predictive PFS (c-index = 0.712) and OS (c-index = 0.722). We have developed a system inflammation score for predicting prognosis of OCCC patients, which may help stratify patients for postsurgical management.

Highlights

Epithelial ovarian cancer remains the fourth leading cause of gynaecological cancer-associated death worldwide
We found that FIGO stage, lymph node metastasis, intraperitoneal metastasis, residual tumor, preoperative ascites, CA125, endometriosis, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and albumin were significant prognostic indicators for progression-free survival (PFS) and overall survival (OS), while age, post-menopausal had no significant association (Table 2)
The serum albumin (HR, 0.49; 95% confidence intervals (CI), 0.27–0.91; P = 0.024), together with FIGO stage, residual tumor, preoperative ascites, and endometriosis were independent predictors for PFS

Summary

Introduction

Epithelial ovarian cancer remains the fourth leading cause of gynaecological cancer-associated death worldwide. Clear cell cancer accounts for 5% of ovarian cancers and is different to the other types of ovarian cancers in terms of biological and clinicopathological characteristics [1,2]. The prognosis for patients with stage I ovarian clear cell carcinoma (OCCC) is relatively good, while advanced stage of OCCC has a worse prognosis than serous ovarian cancers due to be resistant to the standard chemotherapy [3]. Identification of clinical useful prognostic factors, in addition to common clinicopathological risk factors, to predict chemotherapy sensitivity and strengthen disease surveillance for OCCC could improve survival rates.

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