The Prognostic Value Of Preoperative Peripheral Blood Neutrophil/Lymphocyte Ratio In Patients With Epithelial Ovarian Carcinoma

Objective:Epithelial ovarian carcinoma is a disease with high recurrence rate and low survival rate.The purpose of this paper is to explore the relationship between preoperative neutrophil/lymphocyte ratio(NLR) and the clinical factors in patients with epithelial ovarian carcinoma,and clinical significance of preoperative NLR in evaluating the prognosis.Methods:Retrospectively and statistically analyze 188 exact cases of patients with epithelial ovarian carcinoma admitted to the gynecological ward of the first affiliated hospital of Dalian medical university from January 2002 to January 2013.Divided absolute neutrophil count by absolute lymphocyte count, and get NLR. According to the different clinical features, analyze the NLR..Take NLR=2.35 for critical value to separate the medical records into two groups.All patients followed up until December2013. Then compare the lifetime between different groups by univariate and multivariate analysis and analyze the factors influencing prognosis.Results:(1) The lower degree of differentiation, the later stage, higher preoperative CA- 125,preoperative elevated platelets,preoperative appear ascites,residual cancer > 2 cm,lymph node metastasis,pelvic metastasis,and positive peritoneal cytology in such patients,of which the preoperative NLR value is higher,and the difference wasstatistically significant.But,the patients of different ages and different pathological types have no significant statistical differences in NLR.(2) The median preoperative NLR of the group which the progression-free survival time are 12 months or less is significantly higher than the group which the progression-free survival time are above 12 months,there is statistically significant difference.According to the ROC curve,2.35 is uesd as the cut-off of NLR,the sensitivity is 68.7%, the specificity is 58%,and the area under the curve is 0.663, NLR >2.35 for high NLR group(89 cases), NLR= 2.35 or less for low NLR group(99 cases).(3) The median overall survival time of high NLR group and low NLR group are 29 months and 57 months respectively.The median progression-free survival time of high NLR group and low NLR group are 15 months and 30 months respectively,and showed patients in high NLR group have poor prognosis compared with low NLR,there is statistically significant difference.(4) In the early stage(I + II) patients,the median overall survival time of high NLR group and low NLR group are 45 months and 60 months respectively.In patients with advanced stage(stage III + IV),the median overall survival time of high NLR group and low NLR group are 26 months and 34 months respectively.In the patients of both early stage and late stage,the median overall survival time is poorer in the high NLR group than that in the low NLR group,there is statistically significant difference.(5) In patients with cytoreductive surgery satisfied group,the median overall survival time of high NLR group and low NLR group are 40 months and 58 months,respectively,the median progression-free survival time are 15 months and 43 months,respectively,show patients in high NLR group have poor prognosis compared with low NLR,there is statistically significant difference.(6) The median progression-free survival time of patients in elevated group and not elevated group are in 18 months and 24 months respectively,the median overall survival time of patients in elevated group and not elevated group are in 37 months and 40 months respectively,but there is no statistically significant difference.(7) Single factor and multi-factor analysis showed that preoperative peripheral bloodNLR above 2.35 of patients with epithelial ovarian carcinoma is an independent risk factor for overall survival, but preoperative NLR is not progression-free survival time of patients with epithelial ovarian carcinoma independent risk factor.Conclusion:(1) The lower degree of differentiation,the later stage,higher preoperative CA- 125,preoperative elevated platelets,preoperative appear ascites,residual cancer > 2cm, lymph node metastasis,pelvic metastasis,and positive peritoneal cytology in such patients,of which the preoperative NLR value is higher.Higher NLR may indicate tumor progression, make cytoreductive surgery more difficult.(2) Higher preoperative peripheral blood NLR is an independent risk factor for overall survival of patients with epithelial ovarian carcinoma.Higher NLR prompt its poor prognosis.