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. 2009 Jan;58(1):15-23.
doi: 10.1007/s00262-008-0516-3. Epub 2008 Apr 15.

Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment

Hanbyoul Cho  1 , Hye Won Hur, Sang Wun Kim, Sung Hoon Kim, Jae Hoon Kim, Young Tae Kim, Kook Lee
Affiliations

Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment

Hanbyoul Cho et al. Cancer Immunol Immunother. 2009 Jan.

Abstract

Purpose: Inflammatory cells can both suppress and stimulate tumor growth, and the influence of inflammatory cells on clinical outcome has been the focus of many studies. The purpose of this study was to evaluate the effectiveness of the neutrophil to lymphocyte ratio (NLR), a measure of the systemic inflammatory response, as an additional discriminative biomarker in epithelial ovarian cancer and to determine whether it predicts survival and recurrence.

Methods: We studied 192 patients with epithelial ovarian cancer, 173 with benign ovarian tumors, 229 with benign gynecologic disease, and 405 healthy controls. Serum CA125 levels and leukocyte counts according to subtypes were recorded prior to treatment in all study subjects. In epithelial ovarian cancer, the diagnostic usefulness of NLR, in combination with CA125, was evaluated. The correlation between NLR and overall and disease-free survival was analyzed using both univariate and multivariate analyses adjusting for the known prognostic factors (age, stage, cell type, and grade).

Results: Preoperative NLR in ovarian cancer subjects (mean 6.02) was significantly higher than that in benign ovarian tumor subjects (mean 2.57), benign gynecologic disease subjects (mean 2.55), and healthy controls (mean 1.98) (P < 0.001). The sensitivity and specificity of NLR in detecting ovarian cancer was 66.1% (95% CI, 59.52-72.68%) and 82.7% (95% CI, 79.02-86.38%), respectively (cutoff value: 2.60). In early stage ovarian cancer, CA125 was not elevated in 19 out of 49 patients. Seven (36.8%) of these 19 patients were NLR positive. On Cox multivariate analysis, NLR positive, stage III/IV, and older age were independent poor prognostic factors, and being NLR positive was the most powerful predictive variable (Hazard Ratio = 8.42 [95% CI: 1.09-64.84], P = 0.041).

Conclusions: Our findings provide evidence for the association between NLR and epithelial ovarian cancer. Preoperative NLR, in combination with CA125, may represent a simple and cost-effective method of identifying ovarian cancers, and an elevated NLR may predict an adverse outcome in ovarian cancer.

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Figures

Fig. 1
Fig. 1
CA125 levels and NLR in ovarian cancer, benign ovarian tumor, benign gynecologic disease, and healthy control patients. CA125 levels and NLR in ovarian cancer were significantly higher than those in benign ovarian tumor, benign gynecologic disease, and healthy controls
Fig. 2
Fig. 2
Composite analysis of NLR (y-axis) and CA125 (x-axis) levels in patients with early stage ovarian cancer (filled circle) and healthy controls (open diamond). The dotted lines indicate the optimal cutoff value (2.61) of NLR that maximize the sum of sensitivity and specificity and cutoff value of CA125 (35 U/ml)
Fig. 3
Fig. 3
Kaplan–Meier overall survival (P = 0.034) and disease-free survival curves (P = 0.014) for patients with ovarian cancer. NLR positive (>2.60), n = 124, dotted line; NLR negative (≤2.60), n = 68, broken line
See this image and copyright information in PMC

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