Lymphocyte-to-monocyte ratio after primary surgery is an independent prognostic factor for patients with epithelial ovarian cancer: A propensity score matching analysis

Abstract

BackgroundThe aim of this study was to elucidate the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR) after primary surgery in epithelial ovarian cancer (EOC) patients using a propensity score matching (PSM) analysis.MethodsWe retrospectively reviewed consecutive EOC patients who underwent primary surgery between January 2008 and December 2019. Patients were divided into two groups according to the optimal cutoff value of preoperative LMR. PSM (1:1) was conducted to eliminate confounding factors. A Cox proportional hazards model and the Kaplan–Meier estimator were employed to investigate the potential prognostic factors.ResultsA total of 368 EOC patients were included in this study. The optimal cutoff value of LMR was identified as 4.65. Low preoperative LMR was significantly correlated with low albumin, high CA125 level, more blood loss, a high likelihood of ascites, advanced FIGO stage, and poor differentiation (all p < 0.05). After matching, Kaplan–Meier curves showed that the group with LMR < 4.65 experienced significantly shorter OS (p = 0.015). Multivariate Cox analysis revealed that low LMR (HR = 1.49, p = 0.041), advanced FIGO stage (HR = 5.25, p < 0.001), and undefined residual disease (HR = 3.77, p = 0.002) were independent factors in predicting poor OS. A forest plot revealed that LMR had better prognostic value in younger EOC patients, patients with BMI ≥ 25 kg/m2 and albumin ≥ 35 g/L, CA125 ≥ 35 U/L, patients who had undergone optimal surgery, and those who had completed chemotherapy. Additionally, low-LMR patients who had undergone incomplete chemotherapy had a shorter median OS compared with those who completed chemotherapy treatment (48.5 vs. 105.9 months, p = 0.026).ConclusionsLMR could be used as an independent prognostic factor for EOC patients after primary surgery; a noticeable negative effect of LMR was observed among EOC patients with age < 65, good preoperative nutritional status, and more aggressive tumor biology, and among those who underwent optimal surgery. Completing adjuvant chemotherapy is essential to improve survival outcomes among EOC patients with LMR < 4.65 after surgery.

Clinical value of serum tumor markers in assessing the efficacy of neoadjuvant chemotherapy in advanced ovarian cancer: single-center prospective clinical study

“…Lymphocytes, produced in lymphoid organs, are crucial for immune recognition and constitute the main cellular components of the immune response. A decrease in lymphocyte counts can diminish immune-mediated tumor antagonism, thereby facilitating the proliferation and metastasis of malignant tumor cells ( 39 , 40 ). NLR is a leukocyte-associated inflammatory marker suggestive of the body’s immune homeostasis.…”

Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with glioma: a meta-analysis

“…The LMR is derived by dividing the absolute lymphocyte count by the absolute monocyte count. Many studies have reported that LMR is a significant prognostic marker for various solid tumors, including thyroid cancer [ 16 ], renal cell carcinoma [ 17 ], small cell lung cancer [ 18 ], ovarian cancer [ 19 ], and cholangiocarcinoma [ 20 ]. Previous studies have also explored the prognostic effect of LMR in patients with glioma, but the results were controversial [ 21 – 36 ].…”