Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer

IntroductionOvarian cancer is associated with high mortality due to presentation at advanced stage and high recurrence following treatment with chemotherapy. Most of the prognostic variables in ovarian cancer, including stage and residual disease, are amenable for assessment only after surgery. Currently there are no established preoperative markers including, CA-125, that can predict overall survival in patients with ovarian cancer. The aim of our study was to evaluate the prognostic significance of the preoperative haematological markers platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) in patients with ovarian cancer.MethodPreoperative PLR and NLR were evaluated in 235 patients undergoing surgery for ovarian cancer. The prognostic significance of both markers was then determined by both uni- and multivariate analytical methods.ResultsHigh preoperative PLR (p<0.001) and NLR (p=0.001) were significantly associated with poor survival using univariate Cox survival analysis. The median overall survival in patients with a PLR of <300 was 37.4 months (95%CI 26.1–48.7) and 14.5 months (95%CI 11.7–17.2) in those with a PLR of >300. PLR (p=0.03) but not NLR (p=0.575) retained its significance as a prognostic marker on multivariate Cox’s regression analysis, along with stage (p<0.001) and residual disease (p=0.015).ConclusionWe have shown for the first time that PLR is a novel independent prognostic marker in patients with ovarian cancer.

[1]  J. Neoptolemos,et al.  Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. , 2009, American journal of surgery.

[2]  A. Jemal,et al.  Cancer Statistics, 2009 , 2009, CA: a cancer journal for clinicians.

[3]  Giuseppe Garcea,et al.  Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic centre with review of the literature. , 2008, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[4]  D. Gupta,et al.  Role of CA125 in predicting ovarian cancer survival - a review of the epidemiological literature , 2009, Journal of ovarian research.

[5]  E. Wilkinson.  Cancer Research UK , 2002 .

[6]  A. Gadducci,et al.  Serum and tissue biomarkers as predictive and prognostic variables in epithelial ovarian cancer. , 2009, Critical reviews in oncology/hematology.

[7]  K A Baggerly,et al.  New tumor markers: CA125 and beyond , 2005, International Journal of Gynecologic Cancer.

[8]  P. Allavena,et al.  Cancer-related inflammation , 2008, Nature.

[9]  W. Kisiel,et al.  Tumor cell procoagulant and urokinase expression in carcinoma of the ovary. , 1993, Journal of the National Cancer Institute.

[10]  D. Geva,et al.  Ovarian carcinoma associated thrombocytosis. Correlation with prognostic factors and with survival. , 1998, European journal of gynaecological oncology.

[11]  Alberto Mantovani,et al.  Inflammation and cancer: back to Virchow? , 2001, The Lancet.

[12]  E. Ypma,et al.  Lymphocyte Counts Independently Predict Overall Survival in Advanced Cancer Patients: A Biomarker for IL-2 Immunotherapy , 2003, Journal of immunotherapy.

[13]  Lili Chen,et al.  Evaluation of immune inhibitory cytokine profiles in epithelial ovarian carcinoma , 2009, The journal of obstetrics and gynaecology research.

[14]  F. Salazar-Onfray,et al.  Paradoxical effects of cytokines in tumor immune surveillance and tumor immune escape. , 2007, Cytokine & growth factor reviews.

[15]  O. Arrieta,et al.  Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study , 2010, BMC Cancer.

[16]  M. Gore,et al.  Pre-treatment white blood cell subtypes as prognostic indicators in ovarian cancer. , 2008, European journal of obstetrics, gynecology, and reproductive biology.

[17]  R. Zeillinger,et al.  Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer , 2008, Clinical Cancer Research.

[18]  A. Bilici,et al.  The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment , 2010, Medical oncology.

[19]  T. Gungor,et al.  The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors , 2008, Archives of Gynecology and Obstetrics.

[20]  A. Ayhan,et al.  Correlation of Platelet Count With Second-Look Laparotomy Results and Disease Progression in Patients With Advanced Epithelial Ovarian Cancer , 2004, Obstetrics and gynecology.

[21]  M. Karin,et al.  Immunity, Inflammation, and Cancer , 2010, Cell.

[22]  B. Karlan,et al.  The prognostic significance of thrombocytosis in epithelial ovarian carcinoma. , 2004, Gynecologic oncology.

[23]  J W van Wersch,et al.  Whole blood cell counts and leucocyte differentials in patients with benign or malignant ovarian tumours. , 1997, European journal of obstetrics, gynecology, and reproductive biology.

[24]  S. Giardina,et al.  Differentiation of platelet-aggregating effects of human tumor cell lines based on inhibition studies with apyrase, hirudin, and phospholipase. , 1982, Cancer research.

[25]  C. Holmes,et al.  Activated platelets enhance ovarian cancer cell invasion in a cellular model of metastasis , 2009, Clinical & Experimental Metastasis.

[26]  R. Ozols,et al.  Challenges for chemotherapy in ovarian cancer. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[27]  Claudia Marchetti,et al.  First-line treatment of advanced ovarian cancer: current research and perspectives , 2010, Expert review of anticancer therapy.

[28]  E. Feuer,et al.  SEER Cancer Statistics Review, 1975-2003, National Cancer Institute. Bethesda, MD, , 2006 .

[29]  M. Plebani,et al.  Decreased Total Lymphocyte Counts in Pancreatic Cancer: An Index of Adverse Outcome , 2006, Pancreas.

[30]  Sung Hoon Kim,et al.  Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment , 2008, Cancer Immunology, Immunotherapy.