Abstract
IntroductionPrognostic biomarkers are highly needed to properly manage patients with cancer and improve their clinical courses. The relationship between lymphocyte-to-monocyte ratio (LMR) at diagnosis and ovarian cancer prognosis has been extensively studied, but little consensus has been reached regarding its utility as a biomarker of poor outcome. Thus, this study aimed to investigate the potential prognostic value of pretreatment LMR in such patients to shed light on this issue.MethodsWe searched the scientific databases of MEDLINE, Embase, Cochrane Library, and WangFang for relevant studies about the inflammatory prognostic factor LMR in ovarian cancer, based on specific inclusion and exclusion criteria. The following parameters were analyzed among others: LMR values and respective cut-offs, patient’s overall survival (OS) and progression-free survival (PFS), and clinicopathological features.ResultsEight studies, including 2259 patients, were eligible for inclusion in this meta-analysis. We found that low LMR was associated with both poor OS [Hazard ratio (HR): 1.92; 95% confidence interval (CI): 1.58–2.34; p < 0.001] and PFS (HR: 1.70; 95% CI: 1.54–1.88; p < 0.001). Moreover, our findings revealed that low LMR was correlated with high G2/G3 histological grade (OR: 1.67; 95% CI: 1.26–2.20; p < 0.001) and late III-IV FIGO stage tumors (OR: 3.55; 95% CI: 2.68–4.70; p < 0.001), high serum CA-125 level (OR: 2.18; 95% CI: 1.71–2.77; p < 0.001), and presence of malignant ascites (OR: 1.87; 95% CI: 1.11–3.14; p = 0.02) and lymph node metastases (OR: 1.70; 95% CI: 1.13–2.54; p = 0.01).ConclusionPretreatment LMR is a potential prognostic marker of poor outcome in ovarian cancer patients and may thus be important in clinical care and disease control.
Highlights
Prognostic biomarkers are highly needed to properly manage patients with cancer and improve their clinical courses
The cut-off values of lymphocyte-to-monocyte ratio (LMR) ranged from 1.85 to 4.2, which were determined in seven studies by the receiver operating curve sensitivity and specificity analysis (C-index); in one study, the method used was not reported [22]
LMR and progression-free survival Our findings showed a statistically significant negative relationship between LMR and PFS (Fig. 3), in which low values of LMR were associated with worse PFS (HR: 1.70; 95% confidence interval (CI): 1.54–1.88; p < 0.001)
Summary
Prognostic biomarkers are highly needed to properly manage patients with cancer and improve their clinical courses. The relationship between lymphocyte-to-monocyte ratio (LMR) at diagnosis and ovarian cancer prognosis has been extensively studied, but little consensus has been reached regarding its utility as a biomarker of poor outcome. Over 90% of ovarian cancer is of epithelial origin, and non-epithelial tumors are usually derived from the granulosa or germ cells [1]. These differences in ovarian cancer etiology require different diagnostic approaches and result in distinct treatment regimens. Some chemotherapy regimens are associated with increased relapse and mortality rates among patients with ovarian cancer [4]. The use of suitable and improved biomarkers could aid in both the diagnosis and prognosis of ovarian cancer
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