Is neutrophil lymphocyte ratio magic or not?

Abstract

Aim: To evaluate the predictive value of preoperative ratio of neutrophils to lymphocytes (NLR) in distinguishing between benign and malignant masses, as inflammation plays a significant role in the development and emergence of cancer. Material and Method: This retrospective study included 155 patients who underwent surgery due to an adnexal mass between December 2020 and December 2021 (55 were malignant, 100 were benign). Age, parity, tumor stage, chemotherapy, CA 125, CRP, neutrophils, lymphocytes, NLR, were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. The cut-off values of the variables were determined by calculating the areas under the receiver operating characteristic curve (ROC) for the purposes of differential diagnosis in the presence of malignancy, and by analyzing the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood-ratio (LR) (+) values. A P-value of <0.05 was established as the significance level. Results: Malignant tumors showed higher values of neutrophils, CA 125, CRP, and NLR (p=0.018, p=0.0001, p=0.001, p=0.01, respectively), whereas benign group showed higher values of lymphocytes (p=0.011). At cut-off> 2.79 for NLR; sensitivity was found to be 59.36%, specificity 75.51%, positive predictive value (PPV) 58.44, negative predictive value 75.58, LR (+) value 2.3. At cut-off> 36.9 for CA-125; sensitivity was 80.00%, specificity was 78.63%, positive predictive value was 67.72%, negative predictive value was 87.53%, LR (+) value was 3.73. Conclusion: The primary outcome of our study is that the likelihood of malignancy in a patient with an NLR value of>2.79 is 2.3 times higher than in a patient with an NLR value of <2.79 in distinguishing between benign and malignant adnexal masses. The secondary outcome is that the likelihood of malignancy in a patient with a CA-125 value of>36.9 is 3.73 times higher than in a patient with a CA-125 value of <36.9.

Keywords

• NLR
• CA-125
• ovarian cancer

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