| BackgroungOvarian cancer is the seventh most common cancer in the world and the eighth most common cause of cancer deaths affecting women worldwide.It has the third highest incidence but the highest mortality rate among female malignancies.The early symptoms of ovarian cancer are not specific and most cases are diagnosed at a late stage,with approximately 70 percent of patients being at an advanced stage by the time they are detected.Although survival rates for ovarian cancer patients have improved over the last few decades,clinical biomarkers with greater sensitivity and specificity are needed to more accurately assess the prognosis of ovarian cancer patients.In patients with ovarian cancer,prognosis is determined based on the analysis of cancer-related risk factors.High-risk ovarian cancer is associated with a variety of features,including tumour volume size,postoperative residual tumour size,cancer stage,lymph node status,pathological type,histological grade,presence of malignant ascites and tumour marker(CA-125,HE4)levels,which are considered necessary to predict the prognosis of ovarian cancer These features are considered necessary to predict the prognosis of ovarian cancer.For this reason,clinicians and researchers have made extensive efforts to explore biomarkers that predict disease progression,response to treatment and survival.However,there are currently no suitable predictors that can be widely used in the clinical setting,and there is an urgent need for better predictive biomarkers,particularly serum biomarkers,to predict the prognosis of various cancers.The study suggests that inflammatory cells can have a mutagenic effect on cancer cells by releasing chemicals that accelerate the genetic transformation of tumour cells,leading to the evolution of malignant tumours to a more malignant state.In addition,inflammation plays an important role in the initial stages of tumour progression and in some cases can promote the development of early-stage tumours to late-stage tumours.Based on these studies,many studies are now investigating the prognostic value of various clinical indicators based on inflammatory factors in cancer patients,including the Platelets-to-Lymphocyte-Ratio(PLR),Neutrophil-to-Lymphocyte Ratio(NLR)and Lymphocyte-to-Monocyte Ratio(LMR),however,the prognostic value of these markers remains inconclusive.In simple terms,the inflammatory response is characterised by increased levels of neutrophils and monocytes in the circulation,accompanied by a decrease in lymphocyte levels.In the development of cancer,neutrophils and monocytes promote tumour development and metastasis,platelets represent the body’s non-specific response to inflammation,releasing factors such as platelet-reactive protein,which facilitates the blood-borne spread of malignant cells,and lymphocytes induce cytotoxic cell death and inhibit tumour cell proliferation and migration,which are important in preventing cancer proliferation and progression.,PLR and LMR are used as biomarkers of the body’s inflammatory response,which can visually reflect the body’s inflammatory status and immune level.The role of PLR,NLR and LMR in assessing the prognosis of ovarian cancer has been explored in a number of studies.The study by Thavaramara et al.showed no statistically significant correlation between NLR and the prognosis of PFS and OS in ovarian cancer patients,and the results of the study by Miao et al.showed a negative correlation between NLR and PFS and OS;however,the study by Zhang et al.showed that low NLR was Raungkaewmanee et al.found no statistically significant correlation between PLR and PFS and OS prognosis,while a study conducted by Asher et al.showed that high PLR was associated with poor prognosis.In addition many researchers have investigated the prognostic value of LMR in OC patients,with some finding a negative correlation between LMR and survival in OC,however some conclude that LMR does not act as an independent predictor of prognosis in OC patients.Based on this background,further exploration is needed regarding the value of NLR,PLR,and LMR for prognostic assessment and correlation with clinical characteristics of ovarian cancer patients.In addition,some studies have shown a negative correlation between D-dimer levels and survival in patients with ovarian cancer,and an association between ovarian cancer and hypoalbuminemia,where ovarian cancer causes a decrease in serum albumin through a number of mechanisms,including intestinal obstruction,loss of albumin as ascites,malnutrition and inhibition of albumin synthesis.It has been suggested that combined D-dimer and albumin levels can be used as prognostic markers in oesophageal squamous cell carcinoma,nasopharyngeal carcinoma and gastric cancer,and that in combination with these two markers,the Albumin-to-D-dimer Ratio(ADR)may reflect the overall inflammatory,nutritional and coagulation status of cancer patients,however,there are only a few studies on this topic.ObjectiveClinical data from 125 patients with pathological diagnosis of ovarian cancer in the Department of Obstetrics and Gynaecology,were collected from Huaihe Hospital of Henan University,were analysed retrospectively from January 2014 to December 2019.To explore the relationship between preoperative hematologic biomarkers PLR,NLR,LMR and ADR and clinical characteristics of ovarian cancer patients and whether they can play a role in predicting the prognosis of ovarian cancer patients.MethodsFrom January 2014 to December 2019,125 cases of ovarian cancer patients were collected from Huaihe Hospital of University and their prognosis was followed up by telephone and outpatient service.A database of ovarian cancer patients was created.The data were analysed using SPSS(IBM SPSS 25.0,SPSS Inc.).Frequency were used for descriptive analysis of clinical data,and all data were expressed as median.LMR and low LMR groups,and high ADR and low ADR groups,and differences between groups were analysed by chi-squared test;the prognosis of ovarian cancer patients was analysed by Log-Rank test for univariate analysis and COX proportional risk model for multifactorial analysis,and survival curves were plotted by Kaplan-Meier method with Log-Rank test,p<0.05 indicated that the differences were statistically significant.Results1.The optimal cut-off values for NLR,PLR,LMR and ADR were determined from the ROC curves for predicting mortality in patients with ovarian cancer,and the optimal cut-off values for NLR were determined as 3.379 [area under the curve(AUC)= 0.740(p= 0.001)],PLR as 245.273 [area under the curve(AUC)= 0.633(p= 0.066)],LMR as 3.837 [area under the curve(AUC)= 0.706(p= 0.004)],and ADR as 23.895(AUC = 0.805,p= 0.000).2.There was no statistically significant difference between the two groups when comparing age,type of pathology and tissue grading between patients with high NLR and low NLR;there was a statistically significant difference between the two groups in terms of FIGO stage,surgical approach,presence or absence of malignant ascites and the level of CA-125(p<0.05).3.There was no statistically significant difference between the two groups in terms of age and tissue grading when comparing patients with high PLR and low PLR;there was a statistically significant difference between the two groups in terms of pathological type,FIGO stage,surgical method,presence or absence of malignant ascites and the level of CA-125(p<0.05).4.There was no statistically significant difference between the two groups in terms of age and tissue grading when comparing patients with high LMR and low LMR;there was a statistically significant difference between the two groups in terms of type of pathology,FIGO staging,mode of surgery,presence or absence of malignant ascites and the level of CA-125(p<0.05).5.There was no statistically significant difference between the two groups in terms of pathological type,tissue grading,presence or absence of malignant ascites and surgical method when comparing patients in the high and low ADR groups;there was a statistically significant difference between the two groups in terms of age,FIGO stage and the level of CA-125(p<0.05).6.The disease-free survival(DFS)and overall survival(OS)of ovarian cancer patients in the high NLR,high PLR,low LMR and low ADR groups were significantly shorter than those in the low NLR,low PLR,high LMR and high ADR groups,and the differences were statistically significant(p<0.05).7.DFS in ovarian cancer patients was associated with type of pathology(p=0.026),FIGO stage(p= 0.000),surgical approach(p= 0.000),presence or absence of malignant ascites(p= 0.022),the level of CA-125(p= 0.000),the level of NLR(p= 0.000),the level of PLR(p= 0.001),the level of LMR(p=0.001),the level of ADR(p= 0.034).And FIGO stage(HR= 9.184,95% CI= 3.860-21.853,p= 0.000),mode of surgery(HR= 3.949,95% CI= 2.027-7.693,p= 0.000)were independent prognostic influences on disease-free survival(DFS)in patients with ovarian cancer.8.OS in ovarian cancer patients was associated with FIGO stage(p= 0.007),mode of su-rgery(p= 0.000),the level of CA-125(p= 0.047),the level of NLR(p= 0.003),the level of PLR(p= 0.008),the level of LMR(p= 0.009)and the level of ADR(p= 0.000).And mode of surgery(H R=23.618,95% CI=5.402-103.261,p=0.000),PLR(HR=4.170,95% CI=1.017-17.102,p=0.047),ADR(HR=5.140,95% CI=1.479-17.868,p=0.010)were independent prognostic influences on overall s-urvival(OS)of ovarian cancer patients.Conclusions1.Preoperative NLR,PLR,LMR and ADR levels have predictive value in assessing the surgical pathological stage,pathological type,whether radical surgery can be achieved and whether malignant ascites is combined in ovarian cancer patients.2.The disease-free survival and overall survival of patients in the high NLR and high PLR groups were significantly shorter than those in the low NLR and low PLR groups,respectively;the disease-free survival and overall survival of patients in the low LMR and low ADR groups were significantly shorter than those in the high LMR and high ADR groups,respectively.3.NLR,PLR,LMR and ADR were all influential factors for DFS and OS in ovarian cancer patients,of which NLR and PLR were risk factors for prognosis and LMR and ADR were protective factors for prognosis,but only PLR and ADR were independent influencing factors for OS;NLR,PLR,LMR and ADR were not independent influencing factors for DFS. |
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