Neutrophil-to-Lymphocyte Ratio Is a Potential Prognostic Biomarker in Patients with Ovarian Cancer: A Meta-Analysis

Abstract

Background and Aims Plenty of studies were conducted to explore the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer with contradictory results. This study aims to summarize the prognostic significance of NLR in patients with ovarian cancer. Methods A literature search in PubMed, Cochrane Library, and Embase was conducted. The endpoints were progression-free survival (PFS) and overall survival (OS). Results Eleven studies involving a total of 2,892 patients were identified. The results indicated that patients with high NLR had shorter PFS compared to patients with low NLR in ovarian cancer (HR = 1.55, 95% CI = 1.15–2.08, p = 0.004, and I2 = 61%). Similarly, high NLR was related to shorter OS (HR = 1.51, 95% CI = 1.03–2.23, p = 0.04, and I2 = 85%). Moreover, high NLR was significantly associated with shorter PFS when the NLR cut-off was less than 3.3 (p = 0.03) or when treatment is operation (p = 0.002). In addition, high NLR was distinctly related to worse OS in Asian people (p = 0.04) or operation (p = 0.04). Conclusion High NLR was associated with shorter PFS and shorter OS in ovarian cancer. NLR is potentially a promising prognostic biomarker in patients with ovarian cancer.

Combined Plasma Fibrinogen and Neutrophil Lymphocyte Ratio in Ovarian Cancer Prognosis May Play a Role?

“…16 It is thought that an elevated level of NLR reflects increased systemic inflammatory changes in the host, which may be associated with poorer survival in OC. 17 Based on NLR values, an additional prognostic score, combining NLR and fibrinogen levels (F-NLR), has been proposed in different tumors, 18 with interesting results. 19 The aim of our study was to investigate the correlation between NLR, fibrinogen, and F-NLR with survival in our OC population.…”

Neutrophil‐to‐lymphocyte ratio as a prognostic factor in advanced stage ovarian carcinoma treated with neoadjuvant chemotherapy

“…One explanation is that high levels of tumor cytokines leads to recruitment of neutrophils by cancer cells, which subsequently leads to metastasis . On the other hand, lymphocytes play an anti‐cancer role, and high levels of lymphocytes have a positive effect on survival in many cancers . As demonstrated by Milne et al., patients with ovarian cancer had significantly decreased lymphocyte levels at diagnosis compared with levels measured 2 years before diagnosis, and the rate of decline was higher in patients with higher stage.…”

“…This is in concordance with previous studies that assessed the prognostic value of NLR in patients with ovarian cancer. 5,9,19 In a meta-analysis conducted by Chen et al, 19 20 These studies included patients with all disease stages, and elevated levels of NLR upon diagnosis has been previously shown to be associated with advanced stage disease, 5 hence the association between high NLR and survival might in fact be secondary to advanced stage. In the present study, we showed that, even among patients with advanced disease, NLR played a prognostic role in terms of survival.…”

Pretreatment Neutrophil-To-Lymphocyte Ratio (NLR) as a Prognostic Factor of Outcome for Patients with Oral Cavity Squamous Cell Carcinoma: A Single Institution Experience

“…Neutrophils-to-Lymphocytes ratio (NLR) as an expression of systemic inflammatory response to causative agents has shown correlation with outcomes in several malignancies. Breast cancer [5], gastric cancer [6], ovarian cancer [7], Renal cell carcinoma [8], lung cancer [9] and nasopharyngeal cancer [10] are few of the examples. NLR can provide an early and simple indicator for outcome compared with other prognostic factors that would be available only after surgical resection or require advanced laboratory techniques.…”