The Study Of NLR,PLR Combined With CA125 In The Diagnosis And Prognosis Of Epithelial Ovarian Cancer

Objective: To investigate the value of peripheral blood neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)combined with CA125 in the diagnosis and prognosis of epithelial ovarian cancer.Methods: From January 2010 to December 2015 in the Department of Gynecology,Affiliated Hospital of Qingdao University,236 patients with epithelial ovarian cancer(EOC)and 100 patients with benign ovarian tumor were collected for this study.Their clinical data included age,preoperative blood routine(neutrophil count,lymphocyte count,platelet count),CA125,surgical satisfaction,pathological type,tissue differentiation,ascites,ascites/peritoneal lavage fluid with or without cancer cells,pelvic lymph node metastasis,Pelvic organ implantation,FIGO staging,and prognosis followed by telephone,inpatient and outpatient medical records.The best cut-off point of NLR and PLR in clinical diagnosis were determined by the receiver operating characteristic(ROC)curve analysis,and the distribution relationship between the above indictor groups and clinical feature types was analyzed by chi-square test.The sensitivity and specificity of NLR,PLR,CA125 and NLR+PLR+CA125 were evaluated in the epithelial ovarian cancer diagnosis.The accuracy of diagnosis was measured by the area under curve(AUC).Kaplan-Meier method was used to draw survival curve.Univariate analysis was used to analyze the relationship between preoperative NLR,PLR,CA125 and age,surgical satisfaction,pathological type,tissue differentiation,ascites,ascites/peritoneal lavage fluid with or without cancer cells,pelvic/abdominal para-aortic lymph with or without node metastasis,pelvic organ implantation,FIGO stage and overall survival.Log rank test was used to compare the survival rate between groups.Cox regression model was used to analyze the independent risk factor of the overall survival in patients with epithelial ovarian cancer.Result:1.The mean NLR of epithelial ovarian cancer patients was(3.10±3.02),the mean NLR of benign tumor patients was(1.62±0.71),the mean PLR of epithelial ovarian cancer patients was(184.14±100.00),the mean PLR of benign tumor patients was(135.87±50.41),the mean CA125 of epithelial ovarian cancer patients was(793.98±1390.25),the mean CA125 of benign tumor patients was(38.21±102.71)The difference was statistically significant(P<0.001).Therefore,NLR,PLR and CA125 have shown significantly different values in the differential diagnosis of benign and malignant tumors.2.According to ROC curve,NLR=2,PLR=150 are the best cut-off point for clinical diagnosis.The patients were divided into high /low NLR group and high/low PLR group separately.The result of chi-square test showed that there were significant differences(P<0.05)between high and low NLR group in a series of clinical information,such as tumor stages,tissue differentiation,ascites,cancer cells in ascites,CA125,pelvic lymph node metastasis and tumor cytoreductive surgery satisfaction.There were significant differences between high and low PLR group in tumor stage,tissue differentiation,ascites,CA125,pelvic lymph node metastasis and tumor cytoreductive surgery(P<0.05).3.The sensitivity and specificity of biomarkers in this study for the epithelial ovarian cancer diagnosis were shown as follows: NLR(64.4%,76%),PLR(54.7%,75%),CA125(86.7%,81.5%),NLR + PLR + CA125(83.8%,89%).The sensitivity of CA125 detection had the best performance and the specificity of three combined detection was the highest.The accuracy of NLR + PLR+CA125 was higher than that of NLR and PLR alone.4.Kaplan-Meier survival analysis of NLR,PLR,CA125 for overall survival(OS):the survival time of patients with epithelial ovarian cancer in high NLR group,high PLR group and high CA125 group were significantly shorter than their corresponding control group(P<0.05),respectively.5.Univariate analysis showed that age≥50 years,preoperative NLR≥2,PLR≥150,stage III-IV,G3 were risk factors for postoperative overall survival for epithelial ovarian cancer.Multivariate Cox regression analysis showed that high PLR,late tumor stage and unsatisfactory cytoreductive surgery were independent risk factors for overall survival of patients with epithelial ovarian cancer.Conclusion:1.Preoperative high NLR and PLR are associated with late tumor stage,poor differentiation,unsatisfactory cytoreductive surgery,ascites,pelvic organ implantation and short overall survival,which indicates that the epithelial ovarian cancer patients with high NLR,PLR and CA125 would have poor prognosis.2.PLR,tumor stage and satisfactory cytoreductive surgery are independent risk factors for the overall survival of patients with epithelial ovarian cancer.3.The preoperative combination of NLR,PLR and CA125 can improve the diagnostic sensitivity and specificity,and improve the diagnostic rate of epithelial ovariancancer.