Clinical and prognostic value of pre-operative systemic inflammatory markers in clinical course and prognosis of ovarian cancer

Abstract

Objectives: Inflammation plays an important role in the pathogenesis of ovarian cancer. The prognostic value of systemic inflammatory markers is gaining importance in cancer patients. The aim of the present study is to evaluate the clinical and prognostic value of several inflammation markers to include neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and C-reactive protein (CRP), examined pre-operatively in epithelial ovarian cancer patients. Design: Retrospective clinical study. Subjects: A total of 97 patients with epithelial ovarian cancer who underwent primary staging surgery or debulking surgery were analyzed retrospectively. The influence of NLR, PLR values on overall survey (OS) was tested with Kaplan-Meier method and clinical-pathological parameters were tested with chi-square test. Proportional influence of clinical-pathological data on overall survival was tested with hazard ratio uni-variate and multi-variate analyses. Results: Median values of NLR, PLR and CRP were accepted as cut-off value. While elevated NLR (> 2.94) was associated with elevated CA-125 values (p = 0.002), excess amount of ascites (p = 0.023) and presence of residual tumor (p = 0.036); elevated PLR was associated with elevated CA-125 values (p < 0.001), excess amount of ascites (p = 0.001), presence of residual tumor (p = 0.003) and advanced stage (p = 0.013). Elevated CRP values were associated with only elevated CA-125 values (p = 0.013) and excess amount of ascites (p = 0.046). In uni-variate analysis, presence of post-operative residual tumor, > 500 cc ascites, NLR and PLR values were associated with OS; in multi-variate analysis, only stage (p = 0.019) and presence of post-operative residual tumor (p = 0.016) were found to be independent risk factors for OS. Conclusion: Novel prognostic biomarkers are urgently needed for better prediction of survival and definition of novel therapeutic targets.