Preoperative Monocyte-to-Lymphocyte Ratio in Peripheral Blood Predicts Stages, Metastasis, and Histological Grades in Patients with Ovarian Cancer

Abstract

PURPOSE: The monocyte-to-lymphocyte ratio (MLR) has been shown to be associated with the prognosis of various solid tumors. This study sought to evaluate the important value of the MLR in ovarian cancer patients. METHODS: A total of 133 ovarian cancer patients and 43 normal controls were retrospectively reviewed. The patients' demographics were analyzed along with clinical and pathologic data. The counts of peripheral neutrophils, lymphocytes, monocytes, and platelets were collected and used to calculate the MLR, neutrophil-to-lymphocyte ratio (NLR). and platelet-to-lymphocyte ratio (PLR). The optimal cutoff value of the MLR was determined by using receiver operating characteristic curve analysis. We compared the MLR, NLR, and PLR between ovarian cancer and normal control patients and among patients with different stages and different grades, as well as between patients with lymph node metastasis and non–lymph node metastasis. We then investigated the value of the MLR in predicting the stage, grade, and lymph node positivity by using logistic regression. The impact of the MLR on overall survival (OS) was calculated by Kaplan-Meier method and compared by log-rank test. RESULTS: Statistically significant differences in the MLR were observed between ovarian cancer patients and normal controls. However, no difference was found for the NLR and PLR. Highly significant differences in the MLR were found among patients with different stages (stage I-II and stage III-IV), grades (G1 and >G1), and lymph node metastasis status. The MLR was a significant and independent risk factor for lymph node metastasis, as determined by logistic regression. The optimal cutoff value of the MLR was 0.23. We also classified the data according to tumor markers (CA125, CA199, HE4, AFP, and CEA) and conventional coagulation parameters (International Normalized Ratio [INR] and fibrinogen). Highly significant differences in CA125, CA199, HE4, INR, fibrinogen levels, and lactate dehydrogenase were found between the low-MLR group (MLR ≤ 0.23) and the high-MLR group (MLR > 0.23). Correspondingly, dramatic differences were observed between the two groups in OS. CONCLUSION: Our results show that the peripheral blood MLR before surgery could be a significant predictor of advanced stages, advanced pathologic grades, and positive lymphatic metastasis in ovarian cancer patients.

The platelet-to-lymphocyte ratio as a predictor of patient outcomes in ovarian cancer: a meta-analysis

“…Thus, the PLR might be an indicator of treatment response in dose-dense chemotherapy, and can help clinicians to decide when to switch patients to another chemotherapy regimen 27 . A study by Xiang and colleagues compared the MLR together with PLR between OC patients and controls; significant differences were observed 28 . In a study by Kokcu and colleagues, PLR increased progressively with increases in the stage of OC, indicating that it could function as an independent prognostic factor related to the cancer stage 29 .…”

The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma

“…The inflammatory response may be monitored through routine blood analysis. Peripheral blood leukocyte count is a simple and valuable indicator that can reflect the degree of systemic inflammatory response in tumor patients [20], and elevations of NLR, PLR, and MLR are thought to reflect an exaggerated systemic inflammatory response [6-8]. Asari et al [6] found that high PLR could be used as an independent prognostic risk factor in resectable pancreatic ductal carcinoma.…”

“…Ding et al [7] showed that NLR was an independent predictor for colon cancer patients. Xiang et al [8] reported that peripheral blood MLR before surgery could be a significant predictor of advanced stages, advanced pathologic grades, and positive lymphatic metastasis in ovarian cancer patients. Regarding the underlying mechanism, the tumor may cause nonspecific inflammation that leads to a change in leukocyte types.…”

“…The blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are systemic markers of inflammation. Strong evidence suggests that the NLR, PLR, and MLR are independent prognostic factors for survival in multiple tumors [6-8]. …”

Association between Preoperational Blood Profiles and Post Operational Complications in Patients Suffering Epithelial Ovarian Cancer

“…The patients whose monocyte to lymphocyte ratio was higher than 0/23 in compare with her which the ratio is lesser than 0/23 had higher serum levels of HE4, CA19-9 and CA125. There was significant difference in overall survival in two groups too [12]. In the study carried out by Barbo in 2015 in United States the role of leukocytosis and thrombocytosis has been reviewed on post operational complications and mortality rate.…”