Inflammatory indexes as predictive factors for platinum sensitivity and as prognostic factors in recurrent epithelial ovarian cancer patients: a MITO24 retrospective study

Abstract

Neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory index (SII) are prognostic factors in epithelial ovarian cancer (EOC). Their predictive value for platinum-sensitivity and their role in recurrent EOC are unknown. A total of 375 EOC patients were retrospectively analyzed. The correlation between baseline NLR and SII, and platinum-free interval (PFI) according to first line bevacizumab treatment were analyzed using logistic regression analyses adjusted for baseline patient characteristics. Subsequently NLR and SII calculated before second line treatment initiation were evaluated to identify a potential correlation with progression-free survival (PFS) and overall survival (OS) in platinum-sensitive and in platinum-resistant population. In multivariate analysis, NLR ≥ 3 is an independent predictive factor for PFI at 6 months in the chemotherapy group (OR = 2.77, 95% CI 1.38–5.56, p = 0.004), not in bevacizumab treated patients. After having adjusted for ECOG performance status, histology, ascites, bevacizumab treatment at second line and BRCA status, NLR ≥ 3 and SII ≥ 730 are significantly associated with worse OS in platinum-sensitive (HR = 2.69, 95% CI 1.60–4.53, p = 0.002; HR = 2.11, 95% CI 1.29–3.43, p = 0.003, respectively), not in platinum-resistant EOC patients. Low NLR is an independent predictive factor for platinum-sensitivity in patients treated without bevacizumab. NLR and SII are prognostic factors in recurrent platinum-sensitive EOC patients.

Neutrophil-to-Lymphocyte Ratio and Chemotherapy Response Score as prognostic markers in ovarian cancer patients treated with Neoadjuvant Chemotherapy

“…In ovarian cancer, the prognostic signi cance of NLR has been shown in several studies [26,42,44,53] including metanalyses encompassing studies in either gynecological cancers or exclusively ovarian carcinomas [54]. In all the above referenced studies, increased NLR values were associated with worse prognosis and resistance to platinum-based therapy.…”

“…The study included both patients treated with PDS and patients undergoing NACT and IDS approach. Elevated NLR was independently associated with PFS (HR = [42]. Interestingly, NLR lost its predictive value within the bevacizumab-treated population.…”

“…There was also no signi cant association between NLR and PFS in this population (P = 0.084). Finally, a sub analysis of MITO 24 study aimed to evaluate if an elevated NLR (de ned as NLR > 3 alike our study) could associate with clinical outcome [42]. The study included both patients treated with PDS and patients undergoing NACT and IDS approach.…”

“…NLR was de ned as the absolute neutrophil count divided by the absolute lymphocyte count. An elevated NLR was de ned as an NLR > 3 based on previous studies [40][41][42][43][44].…”

Beyond BRCA Status: Clinical Biomarkers May Predict Therapeutic Effects of Olaparib in Platinum-Sensitive Ovarian Cancer Recurrence

“…The CA125 levels were determined using the ARCHITECT i2000SR immunoassay analyzer (Abbott, Chicago, IL, USA). The NLR, which has already been reported as a prognostic factor in EOC, was calculated using the neutrophil/lymphocyte count, and the SII was calculated as platelet count × neutrophil/lymphocyte count ( 20 ). The NLPN score was calculated by multiplying the rNLR by the number of previous drug regimens.…”