Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer

Abstract

Several parameters of preoperative complete blood count (CBC) and inflammation-associated blood cell markers derived from them have been reported to correlate with prognosis in patients with epithelial ovarian cancer (EOC), but their prognostic importance and optimal cutoffs are still needed be elucidated. Clinic/pathological parameters, 5-year follow-up data and preoperative CBC parameters were obtained retrospectively in 654 EOC patients underwent primary surgery at Mayo Clinic. Cutoffs for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were optimized by receiver operating characteristic (ROC) curve. Prognostic significance for overall survival (OS) and recurrence free survival (RFS) were determined by Cox proportional hazards models and Kaplan-Meier method. Associations of RDW and NLR with clinic/pathological parameters were analyzed using non-parametric tests. RDW with cutoff 14.5 and NLR with cutoff 5.25 had independent prognostic significance for OS, while combined RDW and NLR scores stratified patients into low (RDW-low and NLR-low), intermediate (RDW-high or NLR-high) and high risk (RDW-high and NLR-high) groups, especially in patients with high-grade serous ovarian cancer (HGSOC). Moreover, high NLR was associated with poor RFS as well. Elevated RDW was strongly associated with age, whereas high NLR was strongly associated with stage, preoperative CA125 level and ascites at surgery.

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole

“…Red blood cell distribution width (RDW) is a parameter for routine examination of whole blood counts, which is a quantitative measure of changes in circulating red blood cell size . In addition to routine assessments in the differential diagnosis of anemia, studies have shown that there is a hierarchical independent relationship between high RDW levels and the occurrence of cervical, ovarian, and endometrial cancer . Similar to RDW, mean platelet volume, platelet‐to‐lymphocyte ratio, and neutrophil‐to‐lymphocyte ratio have also been reported as inflammatory markers in patients with inflammatory diseases, while they have prognostic significance for cancer …”

Prognostic significance of platelet‐to‐lymphocyte ratio in patients with ovarian cancer: A meta‐analysis

“…PLR is a readily available, routinely measured and inexpensive inflammatory biomarker, which can be easily applied in daily oncologic practice. [17][18][19] We therefore conducted a metaanalysis to assess the prognostic effect of pretreatment PLR in ovarian cancer. a high pretreatment PLR, which also reflects the degree of systemic inflammation, has been found to be linked to prognosis in patients with ovarian cancer.…”

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

“…As mentioned earlier, previous studies chose different cut-offs for elevated NLR based on different methodologies. In the present study cohort, we determined the cut-off of 6.0 based on results from previous studies, 15 and on the fact that the median in the present study cohort was 4.4…”

“…The cut-off of 6.0 was chosen based on its association with poor outcome according to previous studies. 15,16 The primary outcome was the result of the interval surgical intervention defined as optimal debulking (<1 cm residual disease). NACT was offered to patients with advanced stage ovarian carcinoma who therefore had a low likelihood of achieving optimal debulking in primary cytoreduction, or those with high perioperative risk profile.…”