Serum D-dimer, albumin and systemic inflammatory response markers in ovarian clear cell carcinoma and their prognostic implications

Abstract

Background: This study attempts to evaluate whether preoperative systemic inflammatory response (SIR) markers or other hematological variables, such as albumin, D-dimer, and carbohydrate antigen 125, play roles in predicting chemotherapy response and survival outcome in patients with ovarian clear cell carcinoma (OCCC).

Methods: Preoperative leukocyte differential counts, as well as platelet, serum albumin, plasma D-dimer and CA-125 levels, were measured in patients with FIGO IC-IV ovarian clear cell cancer. The correlations of these hematological biomarkers with clinicopathological features, chemotherapy response, and survival outcomes were further analyzed. Survival time was estimated using the Kaplan-Meier model, whereas Cox regression was conducted for multivariate analysis.

Results: Among the 84 patients, 28.6% were classified as platinum resistant, and 69.0% were platinum sensitive. Preoperative CA125, albumin, and D-dimer levels; neutrophil to lymphocyte ratios (NLR); and monocyte to lymphocyte ratios were significantly correlated with FIGO stage, residual tumor, and platinum response. Platelet to lymphocyte ratio was not related to platinum response (P = 0.060). The median follow-up time was 28 months (range, 1 to 128 months). Preoperative CA125, albumin, and D-dimer levels were significant prognostic factors for overall survival (OS) and progression-free survival (PFS). In the univariate analysis, only NLR exhibited prognostic significance for PFS (P = 0.007). Multivariate analysis indicated that D-dimer > 3.27 (P = 0.001 for OS; P = 0.040 for PFS) and albumin < 39.6 (P = 0.005 for OS and P = 0.041 for PFS) retained significance.

Conclusions: Preoperative NLR has some predictive value for platinum resistance in patients with IC-IV stage OCCC but has little predictive effect on prognosis. Elevated D-dimer and reduced albumin might be potential biomarkers for worse response to first-line platinum-based chemotherapy and poor clinical outcomes.

Keywords: Albumin; Clear cell carcinoma; D-dimer; Neutrophil to lymphocyte ratio; Ovarian neoplasms; Platinum resistance; Recurrence; Survival.

Fig. 1

Receiver operating characteristic curve demonstrating the AUC of preoperative MLR, NLR, CA125, D2, and ALB for platinum resistance. (Abbreviations: AUC, the area under the curve; MLR, monocyte-to-lymphocyte ratio; NLR, neutrophil to lymphocyte ratio; CA125, carbohydrate antigen 125; D2, D-dimer; ALB, albumin)

Fig. 2

Kaplan-Meier curves showing PFS and OS stratified by preoperative ALB (a), D2 (b), and groups combining ALB and D2 (c). Group 1, high ALB/low D2; group 2, high ALB/high D2 and low ALB/low D2; group 3, low ALB/high D2. The p-values were calculated using the log-rank test. (Abbreviations: ALB, albumin; D2, D-dimer; PFS, progression-free survival; OS, overall survival)

Fig. 3

The risk of disease progression and death compared to ALB-high and D2-low. (Abbreviations: ALB, albumin; D2, D-dimer)