Role of Neutrophil to Lymphocyte Ratio as a Prognostic Indicator for Epithelial Ovarian Cancer
Thaovalai Thavaramara MD*, Chadakarn Phaloprakarn MD*, Siriwan Tangjitgamol MD*, Sumonmal Manusirivithaya MD*
Affiliation : * Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand
Objective : To determine whether level of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) was a prognostic
indicator for epithelial ovarian cancer (EOC) patient. The present study further aimed to evaluate the impact of the change of
preoperative/ postoperative NLR on the survival.
Material and Method: Medical records of the patients undergoing an operation for EOC in Vajira Hospital between
January 1, 2004 and December 31, 2009 were reviewed. Demographic, clinicopathological, and laboratory data were
assessed. Preoperative NLR level was divided into high (more than 2.6) and low (2.6 or less) groups and their association
with survival were determined. The survival of the subjects according to their preoperative NLR compared to postoperative
level was also evaluated.
Results : Mean age of 129 subjects was 49.6 + 12.5 years. Median pre- and post-operative NLR were 2.8 (range 0.86 to 30.0)
and 2.7 (range 0.16 to 31.3), respectively. Seventy-one patients (55.0%) had high preoperative NLR and 64 (53.8%) had
high postoperative value. High preoperative and pre- and post-operative NLR were significantly associated with advanced
stage and suboptimal surgery. While high post-operative NLR was significantly associated with advanced stage but not
suboptimal surgery. In univariable analysis, preoperative/postoperative high/high NLR tended to associate with poor progression
free survival (PFS) but not overall survival (OS), with p = 0.019 and p = 0.052 respectively. By multivariable analysis, the
advanced stage and suboptimal surgery, but not preoperative and postoperative NLR, were independent poor prognostic
factors for PFS and OS.
Conclusion : The level of preoperative NLR and the change of preoperative/postoperative NLR level tended to associate with
PFS more than OS of EOC patient.
Keywords : Epithelial ovarian cancer, Neutrophil to lymphocyte ratio, Prognostic indicator, Survival
