Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer

Abstract

Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory. This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer. Material and methods: NLR, PLR, and MLR were calculated from preoperative blood samples of 63 treatment-naive ovarian cancer patients (58 serous, 92.1%) who underwent primary debulking surgery. FIGO 2021 staging criteria were used. Mann-Whitney U and Kruskal-Wallis tests (with Bonferroni correction) were used for intergroup comparisons; multivariate logistic regression analysis was applied to determine independent predictors. The discriminative performance of MLR was evaluated using ROC analysis. Results: 92.1% of the cohort had serous histology, and 61.9% had advanced-stage disease (FIGO stages III-IV). In multivariate analysis (adjusted for age and menopause), only MLR was found to be independently associated with advanced-stage disease (adjusted OR: 4.25; 95% CI: 1.24-14.49; p=0.021). NLR and PLR showed no significance. MLR was also associated with peritoneal metastasis (p=0.017) and intestinal infiltration (p=0.019). In ROC analysis, the AUC was 0.706 (95% CI: 0.567-0.845; p=0.006). The optimal cut-off value was determined as 0.30 (sensitivity 48.7%, specificity 91.7%); an alternative cut-off value of 0.17 (sensitivity 82.1%, specificity 50.0%) was evaluated for high sensitivity. Conclusion: In treatment-naive serous ovarian cancer, MLR demonstrated superior performance compared to NLR and PLR in predicting advanced disease and peritoneal metastasis (adjusted OR: 4.25; AUC: 0.706). This finding supports the clinical significance of the monocyte-macrophage axis in serous ovarian cancer with predominantly transcoelomic spread. The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.

Keywords

• ovarian cancer
• serous carcinoma
• monocyte-lymphocyte ratio
• peritoneal metastasis
• inflammatory markers

Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer

Abstract

Amaç: Over kanserinde sistemik inflamatuvar belirteçlerin prognostik değeri çelişkilidir. Bu çalışma, tedavi-naif seröz over kanserinde monosit-lenfosit oranının (MLR) ileri evre hastalık ve peritoneal metastazı öngörme performansını nötrofil-lenfosit (NLR) ve trombosit-lenfosit oranı (PLR) ile karşılaştırmayı amaçlamıştır. Yöntem: Primer debulking cerrahi uygulanan 63 tedavi-naif over kanseri hastasının (58 seröz, %92.1) preoperatif kan örneklerinden NLR, PLR ve MLR hesaplandı. FIGO 2021 evreleme kriterleri kullanıldı. Gruplar arası karşılaştırmada Mann-Whitney U ve Kruskal-Wallis testleri (Bonferroni düzeltmeli) kullanıldı; bağımsız prediktörlerin belirlenmesinde çok değişkenli lojistik regresyon analizi uygulandı. MLR'nin diskriminatif performansı ROC analizi ile değerlendirildi. Bulgular: Kohortun %92.1'i seröz histolojiye, %61.9'u ileri evre (FIGO evre III-IV) hastalığa sahipti. Çok değişkenli analizde (yaş ve menopoz için düzeltilmiş), sadece MLR ileri evre hastalıkla bağımsız ilişkili bulundu (düzeltilmiş OR: 4.25; %95 GA: 1.24-14.49; p=0.021). NLR ve PLR anlamlılık göstermedi. MLR peritoneal metastaz (p=0.017) ve intestinal infiltrasyon (p=0.019) ile de ilişkiliydi. ROC analizinde AUC 0.706 (%95 GA: 0.567-0.845; p=0.006) bulundu. Optimal cut-off değeri 0.30 (sensitivite %48.7, spesifisite %91.7) olarak belirlendi; yüksek sensitivite için alternatif cut-off değeri 0.17 (sensitivite %82.1, spesifisite %50.0) değerlendirildi. Sonuç: Tedavi-naif seröz over kanserinde MLR, ileri evre hastalık ve peritoneal metastazı öngörmede NLR ve PLR'ye kıyasla üstün performans göstermiştir (düzeltilmiş OR: 4.25; AUC: 0.706). Bu bulgu, transkoelomik yayılımın baskın olduğu seröz over kanserinde monosit-makrofaj aksının klinik önemini desteklemektedir. MLR'nin prognostik değeri ve optimal cut-off değerleri prospektif çok merkezli çalışmalarla doğrulanmalıdır.

Keywords

• over kanseri
• seröz kanser
• monosit-lenfosit oranı
• periton metastazı
• inflamatuar markerlar

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