Diagnostic Value Of Serum CA125 Combined With NLR And PLR In Epithelial Ovarian Cancer

Background and Objectives:Ovarian cancer is a common malignant tumor in gynecology.About 15.7%of patients with ovarian cancer were diagnosed in the early stage,with a 5-year survival rate of 92.6%,while about 58%of patients with ovarian cancer were diagnosed in the late stage,with a 5-year survival rate of only 30.2%.Despite advances in the treatment of ovarian cancer,the 5-year overall survival rate for ovarian cancer patients is only 45%,and the disease has the highest mortality rate among the three most common gynecological malignancies.Epithelial ovarian cancer(EOC)is the most common pathological type of ovarian cancer.About 75%of epithelial ovarian cancer only show symptoms in its advanced stage,while patients with early-stage epithelial ovarian cancer only show some mild and atypical symptoms.In addition,due to the lack of means for early diagnosis,EOC is often diagnosed at a late stage,which is also one of the reasons for the high mortality rate and poor prognosis of EOC.Therefore,it has become a hot spot in ovarian cancer research to find a simple and accurate biomarker for differential diagnosis of epithelial ovarian cancer.Chronic inflammation has been proved to be one of the main factors for the growth,progression and metastasis of malignant tumors in human body.Chronic inflammatory response stimulated by tumor cells can inhibit the apoptosis of malignant tumor cells and promote the generation of new blood vessels,leading to irreversible DNA damage.Facts have shown that this process can promote the continuous growth of malignant tumors and infiltrate into surrounding tissues,and finally metastasize to other organs in the body.In addition,platelets contribute to the continuous growth and progression of malignant tumors in the body by releasing growth factors,such as platelet-derived growth factor,transforming growth factor β and vascular endothelial growth factor.As the number of platelets increases,so does the release of growth factors from platelets,so thrombocytosis is often associated with poor prognosis.Inflammatory markers in serum,such as the Neutrophil to Lymphocyte ratio(NLR)and Platelet to Lymphocyte ratio(PLR),have been the subject of many cancer studies.Serum levels of inflammatory markers have also been shown to vary significantly across different types of cancer.Due to the high mortality rate,poor prognosis and difficulties in early diagnosis of epithelial ovarian cancer,it is particularly important to find a biomarker that can be easily obtained and more accurately differentiated and diagnosed.In this study,retrospective study was used to explore the diagnostic value of serum CA125 combined with NLR and PLR in EOC,with a view to providing a new simple and feasible auxiliary diagnostic method for the clinical diagnosis of epithelial ovarian cancer,so as to improve the early diagnosis rate of epithelial ovarian cance.Materials and Methods:Clinical data of patients diagnosed with EOC(n=242)and benign ovarian tumor(n=181)in the First Affiliated Hospital of Chongqing Medical University from January 2018 to May 2020 were retrospectively analyzed.The diagnostic accuracy of CA125,NLR and PLR was determined by the receiver operating characteristic curve and the area under the AUC curve,and the optimal cut-off value of CA125,NLR and PLR was determined by the maximum approximate landing index.At the same time,the sensitivity and specificity of single and combined CA125,NLR and PLR were evaluated for EOC diagnosis.Chi-square test was used to compare the clinicopathological parameters of NLR,PLR and EOC.Result:1.In all,242 patients with EOC and 181 patients with benign ovarian tumors were included.Patients with EOC were older than those with benign ovarian tumors(P<0.05).CA125,neutrophil count,platelet count,NLR and PLR in epithelial ovarian cancer patients were significantly higher than those in benign ovarian tumor patients,while lymphocyte count was significantly lower than those in benign ovarian tumor patients(P<0.05).BMI(P=0.150)and maximum tumor diameter(P=0.495)showed no statistically significant differences between the two groups.2.Receiver operating characteristic curve showed that when benign ovarian tumor was taken as the control group,the AUC of CA125,NLR and PLR in the diagnosis of epithelial ovarian cancer was respectively:0.934,0.785,0.886.The results indicated that CA125 had a high diagnostic accuracy in differentiating benign ovarian cancer from epithelial ovarian cancer,while NLR and PLR alone had poor diagnostic accuracy in differentiating benign ovarian cancer from ovarian cancer.It is not enough to be used as a diagnostic marker for epithelial ovarian cancer alone.3.Receiver operating characteristic curve showed that when Youden index is maximized,the optimal cut-off values of CA125,NLR and PLR are 40.2U/mL,2.29 and 161.72,respectively.The diagnostic sensitivity in differentiating benign and malignant ovarian tumors is:The specificity of CA125 was 89.26%,67.77%,76.03%,and 87.85%,77.9%,and 90.06%,respectively.Therefore,when benign ovarian tumor was taken as the control group,CA125 had the highest sensitivity and poor specificity in the diagnosis of EOC,while PLR had a higher specificity in the diagnosis of EOC.4.The value of CA 125 combined with NLR and PLR in differentiating benign ovarian tumors from epithelial ovarian cancer was analyzed and compared by receiver operating characteristic curve.The results showed that the sensitivity and specificity of CA125 combined with NLR in differentiating benign and malignant ovarian tumors were 87.6%and 88.4%,which were higher than that of CA125 alone(P=0.77).The sensitivity and specificity of CA125 combined with PLR in the diagnosis of EOC were 85.12%and 92.82%,which were significantly increased compared with CA125 alone(P=0.04).The sensitivity and specificity of CA125 combined with NLR and PLR in the diagnosis of EOC were 88.02%and 91.71%,which increased compared with the diagnosis of CA125 alone(P=0.06).5.Peripheral blood NLR(P<0.01)and PLR(P<0.01)were higher in patients with advanced(stage Ⅲ-Ⅳ)EOC than in patients with early(stage I-II)EOC.Serous ovarian cancer had higher serum NLR(P<0.01)and PLR(P<0.01)than non-serous ovarian cancer.NLR(P<0.01)and PLR(P<0.01)in peripheral blood were also significantly increased in poorly differentiated(G2-G3)EOC compared with highly differentiated(G1)epithelial ovarian cancer.The NLR and PLR in peripheral blood were higher in EOC combined with a large amount of ascites(≥500 ml)than in EOC combined with a small amount of ascites(<500 ml)(P<0.01,P<0.01).Conclusion:1.Compared with the benign ovarian tumor,the levels of NLR and PLR in EOC were significantly higher,suggesting that PLR and NLR have certain value in the differential diagnosis of EOC and benign ovarian tumor.2.The higher NLR and PLR in the serum of patients with EOC,the greater likelihood of serous epithelial ovarian cancer.3.The higher the serum NLR and PLR in patients with EOC,the later the stage,the poorer the tissue differentiation,and the greater the possibility of ascites.It is expected that NLR and PLR combined with serum CA125 can be used as biochemical indexes for the evaluation of patients with EOC.4.Compared with CA125 alone in the diagnosis of EOC,CA125 combined with NLR and PLR,especially combined with PLR,can improve the specificity of CA125 in the diagnosis of EOC,and it is clinically simple,effective and safe,and can be used to assist in the diagnosis of EOC.