Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer

Abstract

Ovarian cancer remains one of the most lethal gynaecological malignancies affecting women worldwide; therefore, attention has been focused on identifying new prognostic factors which might help the clinician to select cases who could benefit most from surgery versus cases in which neoadjuvant systemic therapy followed by interval debulking surgery should be performed. The aim of the current paper is to identify whether preoperative inflammation could serve as a prognostic factor for advanced-stage ovarian cancer. Material and methods: The data of 57 patients who underwent to surgery for advanced-stage ovarian cancer between 2014 and 2020 at the Cantacuzino Clinical Hospital were retrospectively reviewed. The receiver operating characteristic curve was used to determine the optimal cut-off value of different inflammatory markers for the overall survival analysis. The analysed parameters were the preoperative level of CA125, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation index (SII). Results: Baseline CA125 > 780 µ/mL, NLR ≥ 2.7, MLR > 0.25, PLR > 200 and a systemic immune inflammation index (SII, defined as platelet × neutrophil-lymphocyte ratio) ≥ 84,1000 were associated with significantly worse disease-free and overall survival in a univariate analysis. In a multivariate analysis, MLR and SII were significantly associated with higher values of overall survival (p < 0.0001 and p = 0.0124); meanwhile, preoperative values of CA125, PLR and MLR were not associated with the overall survival values (p = 0.5612, p = 0.6137 and p = 0.1982, respectively). In conclusion, patients presenting higher levels of MLR and SII preoperatively are expected to have a poorer outcome even if complete debulking surgery is performed and should be instead considered candidates for neoadjuvant systemic therapy followed by interval surgery.

Keywords: monocyte-to-lymphocyte ratio; peritoneal carcinomatosis; platelet-to-lymphocyte ratio; preoperative inflammation; systemic inflammation index.

Figure 1

Receiver operating characteristics curve analysis of CA125, monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII).

Figure 2

Kaplan–Meyer curves based on preoperative values of CA125: patients with higher values of CA125 reported a mean overall survival of 16.97 months, while cases with lower CA125 values reported a mean overall survival of 43.61 months, p < 0.001.

Figure 3

Kaplan–Meyer curves based on preoperative values of MLR: patients with higher values of MLR reported a mean overall survival of 15.62 months while cases, with lower MLR values reported a mean overall survival of 45 months, p < 0.001.

Figure 4

Kaplan–Meyer curves based on preoperative values of NLR: patients with higher values of NLR reported a mean overall survival of 15.32 months, while cases with lower NLR values reported a mean overall survival of 44.2 months, p < 0.001.

Figure 5

Kaplan–Meyer curves based on preoperative values of PLR: patients with higher values of PLR reported a mean overall survival of 17 months, while cases with lower PLR values reported a mean overall survival of 43.6 months, p < 0.001.

Figure 6

Kaplan–Meyer curves based on preoperative values of SII: patients with higher values of SII reported a mean overall survival of 15 months, while cases with lower SII values reported a mean overall survival of 44 months, p < 0.001.

Figure 7

Kaplan–Meyer curves of DFS based on the preoperative levels of CA125. Patients with higher values of CA125 reported a median DFS rate of 11 months, while cases with lower CA125 values reported a mean overall survival of 30 months, p = 0.002.

Figure 8

Kaplan–Meyer curves of DFS based on the preoperative levels of MLR. Patients with higher values of MLR reported a median DFS rate of 12 months, while cases with lower MLR 125 values reported a mean overall survival of 28 months, p = 0.003.

Figure 9

Kaplan–Meyer curves of DFS based on the preoperative levels of NLR. Patients with higher values of NLR reported a median DFS rate of 13 months, while cases with lower NLR values reported a mean overall survival of 33 months, p = 0.0001.

Figure 10

Kaplan–Meyer curves of DFS based on the preoperative levels of PLR. Patients with higher values of PLR reported a median DFS rate of 14 months, while cases with lower PLR values reported a mean overall survival of 28 months, p = 0.01.

Figure 11

Kaplan–Meyer curves of DFS based on the preoperative levels of SII. Patients with higher values of SII reported a median DFS rate of 12 months, while cases with lower SII values reported a mean overall survival of 31 months, p = 0.006.