| Objective: Ovarian cancer,as a malignant tumor with poor prognosis,persistent drug resistance and frequent recurrence,is one of the major causes of cancer-related death in women.Finding an economical,reliable and effective clinical indicator to evaluate the prognosis of ovarian cancer patients has become a hot topic at present.This study evaluated the Ratio of hemoglobin to erythrocyte distribution width(HRR)before treatment by analyzing the differences in clinical cases of patients with different stages of epithelial ovarian cancer and Systemic inflammatory(SIR)indicators,such as: Platelet count to lymphocyte count ratio(PLR),Neutrophil count to lymphocyte count ratio(NLR),Monocyte count to lymphocyte count ratio(MLR)in patients with advanced serous ovarian cancer after treatment and the impact on the prognosis of patients.To find an economical and effective clinical biological index can effectively predict the prognosis of patients with ovarian cancer.Methods: A total of 225 patients with epithelial serous ovarian cancer initially diagnosed in Affiliated Hospital of Qingdao University from January 2017 to June 2019 were retrospectively analyzed,among which the pathological type with the largest number of patients was Stage Ⅲhigh-grade serous ovarian cancer(170 cases in total).The clinical data of the patients were recorded,such as age,pathological and histological differentiation type,treatment regimen,blood parameters,ultrasound and imaging examination results,and progression free survival(PFS)of the patients was followed up.In order to exclude the influence of tumor stage and differentiation on prognosis,this study mainly explored the influence of HRR,NLR,PLR and MLR on prognosis of stage Ⅲhigh-grade serous ovarian cancer.SPSS statistical software was used to calculate the specificity,sensitivity and accuracy of simple rule models of HRR,NLR,PLR and MLR.The receiver operating characteristic curve was described and the area under ROC was calculated to evaluate the predictive value of preoperative HRR,NLR,PLR and MLR in the recurrence of stage Ⅲhigh-grade serous ovarian cancer.Kaplan-Meier survival curve was used to analyze the effects of HRR,NLR,PLR and MLR on PFS of stage Ⅲhigh-grade serous ovarian cancer,and COX univariate and multivariate regression was used to analyze the risk factors affecting PFS of patients.P < 0.05 was considered statistically significant.Results :1.Among the 225 patients with epithelial serous ovarian cance included in the study,225 patients with epithelial ovarian cancer were divided into stage Ⅰ-Ⅱ group and stage III-IV group according to FIGO staging.There was no statistically significant difference in age and BMI between the two groups.Serum albumin concentration,CA125 value,anemia status,HRR,NLR,PLR and MLR were compared between the two groups,and the differences were statistically significant.2.Predictive value of HRR,NLR,PLR,MLR and combined detection before treatment on three-year recurrence of stage Ⅲhigh grade serous ovarian cancer: The optimal critical values of HRR,NLR,PLR and MLR were 2.9638(95%CI: 0.572-0.747),3.5515(95%CI: 0.572-0.747),196.6948(95%CI: 0.601-0.773),and 0.3235(95%CI: 0.506-0.700)respectively.The AUC values of HRR,NLR,PLR and MLR before treatment were 0.748,0.659,0.687 and 0.603,respectively.The sensitivity(%)were 0.857,0.571,0.765,0.622;The specificity(%)were 0.570,0.787,0.596 and 0.596,respectively.3.According to the optimal truncation values of HRR,NLR,PLR and MLR calculated by the subject working curve,the patients with stage Ⅲhigh-grade ovarian cancer were divided into low HRR group(HRR < 2.9638)and high HRR group(HRR≥2.9638).The relationship between the case characteristics of the two groups was compared.The results showed that: There were no significant differences in age,serum albumin level,BMI,chemotherapy response and MLR between the two groups(P < 0.05);Compared with the high-value group,the low-value HRR group had lower higher lymphatic metastasis rate,and higher NLR and PLR values,the differences were statistically significant(P < 0.05).4.The relationship between HRR,NLR,PLR,MLR and PFS in patients with III HGSOC: Kaplan-Meier analysis showed that HRR was significantly correlated with PFS in patients with Stage III HGSOC(Log-rank P < 0.001).The mean PFS in patients with low HRR and high HRR were 18 months and 30 months,respectively,and the median PFS were 17 months and 21 months.NLR was significantly correlated with PFS in Stage III HGSOC patients(Log-rank P < 0.001),with mean PFS of 30 months and 16 months in low-value and high-value NLR groups,and median PFS of 23 months and 16 months,respectively.PLR was significantly associated with PFS in patients with Stage III HGSOC(Log-rank P< 0.001),with mean PFS of 33 months and 19 months,respectively,and median PFS of 30 months and 16 months in patients with low PLR and high PLR.There was no significant correlation between MLR and PFS in patients with Stage III HGSOC(Log-rank P =0.137).The mean PFS in patients with low MLR and high MLR were 27 months and 21 months,respectively,and the median PFS was 18 months in both groups.5.In univariate analysis,HRR,NLR and PLR were correlated with progression-free survival of stage III HGSOC patients.Decreased HRR level and increased NLR and PLR value were adverse factors affecting the prognosis of stage III HGSOC patients.In multivariate analysis,MLR level was not significantly correlated with progression-free survival in patients with stage III HGSOC,while HRR and NLR were significantly correlated with progression-free survival in patients with stage III HGSOC,suggesting that HRR and NLR levels are independent risk factors affecting prognosis in patients with stage Ⅲhigh-grade serous ovarian cancer.Conclusion :1.HRR values in advanced epithelial ovarian cancer patients are lower than those in early stage patients,while NLR,PLR and MLR values are higher than those in early stage patients.2.The predictive efficacy of HRR in the recurrence of stage Ⅲhigh-grade ovarian cancer is higher than other SIR Indicators;Low level of HRR indicates high incidence of lymph node metastasis,high NLR and PLR values;3.HRR,NLR and PLR are prognostic factors for patients with stage Ⅲhigh-grade serous ovarian cancer,while HRR and NLR are independent risk factors for the prognosis of these patients.Lower levels of HRR and higher levels of NLR suggest shortened progression-free survival and poor prognosis. |
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