Tumor Biology

, Volume 36, Issue 11, pp 8831–8837 | Cite as

Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients

  • Wei-wei Zhang
  • Ke-jun Liu
  • Guo-lin Hu
  • Wei-jiang LiangEmail author
Research Article


The aim of the present study was to determine the most meaningful preoperative prognostic factor of cancer-related death in ovarian cancer patients by comparing potentially prognostic systemic inflammatory response (SIR) markers. The levels of fibrinogen, albumin, C-reactive protein (CRP), and serum cancer antigen-125 (CA-125) and the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were evaluated in 190 ovarian cancer patients to identify predictors of overall survival (OS) and progression-free survival (PFS) using univariate and multivariate analyses. Patients with a PLR >203 had a shorter PFS and OS than the patients in PLR ≤203 group (11 vs. 24 months and 28 vs. 64 months). Univariate analyses revealed that tumor stage, postoperative residual tumor mass, ascites, and the levels of all SIR markers were associated with PFS and OS. Multivariate analysis revealed that PLR was independently associated with PFS (hazard ratio [HR] 1.852, 95 % confidence interval [CI] 1.271–2.697, P = 0.001) and OS (HR 2.158, 95 %CI 1.468–3.171, P < 0.001), as well as tumor stage and postoperative residual tumor mass. In contrast, fibrinogen remained significant only for PFS (HR 1.724, 95 %CI 1.197–2.482, P = 0.003). Patients with a PLR >203 were more prone to have advanced tumor stage (P = 0.002), postoperative residual tumor mass >2 cm (P = 0.032), malignant ascites (P < 0.001), and all the other elevated SIR markers (P < 0.001). Preoperative PLR is superior to other SIR markers (CA-125, NLR, fibrinogen, CRP, and albumin) as a predictor of survival in ovarian cancer patients.


Platelet/lymphocyte ratio Prognostic factor Systemic inflammatory response markers Ovarian cancer 



Wei-wei Zhang and Ke-jun Liu contributed equally to this work. The authors would like to thank doctors, nurses, patients, and their family members for their kindness to support our study.

Grant support

The Department of the Science and Technology Planning Project Fund of Guangdong Province in China (2011B031800042).

Conflicts of interest



  1. 1.
    Cohen CA, Shea AA, Heffron CL, Schmelz EM, Roberts PC. The parity-associated microenvironmental niche in the omental fat band is refractory to ovarian cancer metastasis. Cancer Prev Res (Phila). 2013;6:1182–93.CrossRefGoogle Scholar
  2. 2.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.CrossRefPubMedGoogle Scholar
  3. 3.
    Hirashima K, Watanabe M, Shigaki H, Imamura Y, Ida S, Iwatsuki M, et al. Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer. J Gastroenterol. 2014;49:1040–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Wu N, Chen G, Hu H, Pang L, Chen Z. Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas. Nutr Cancer. 2015;67:481–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Oh BS, Jang JW, Kwon JH, You CR, Chung KW, Kay CS, et al. Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma. BMC Cancer. 2013;13:78.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288–95.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chen Q, Yang LX, Li XD, Yin D, Shi SM, Chen EB, et al. The elevated preoperative neutrophil-to-lymphocyte ratio predicts poor prognosis in intrahepatic cholangiocarcinoma patients undergoing hepatectomy. Tumour Biol. 2015. doi: 10.1007/s13277-015-3188-6.
  8. 8.
    Bishara S, Griffin M, Cargill A, Bali A, Gore ME, Kaye SB, et al. Pre-treatment white blood cell subtypes as prognostic indicators in ovarian cancer. Eur J Obstet Gynecol Reprod Biol. 2008;138:71–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Kisielewski R, Tolwinska A, Mazurek A, Laudanski P. Inflammation and ovarian cancer—current views. Ginekol Pol. 2013;84:293–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Freedman RS, Deavers M, Liu J, Wang E. Peritoneal inflammation—a microenvironment for Epithelial Ovarian Cancer (EOC). J Transl Med. 2004;2:23.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Honn KV, Tang DG, Crissman JD. Platelets and cancer metastasis: a causal relationship? Cancer Metastasis Rev. 1992;11:325–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J, et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med. 2012;366:610–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Petri AL, Hogdall E, Christensen IJ, Kjaer SK, Blaakaer J, Hogdall CK. Preoperative CA125 as a prognostic factor in stage I epithelial ovarian cancer. APMIS. 2006;114:359–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Asher V, Lee J, Bali A. Preoperative serum albumin is an independent prognostic predictor of survival in ovarian cancer. Med Oncol. 2012;29:2005–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Hefler LA, Concin N, Hofstetter G, Marth C, Mustea A, Sehouli J, et al. Serum C-reactive protein as independent prognostic variable in patients with ovarian cancer. Clin Cancer Res. 2008;14:710–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, et al. Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecol Oncol. 2014;132:542–50.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol. 2011;13:499–503.CrossRefPubMedGoogle Scholar
  18. 18.
    Polterauer S, Grimm C, Seebacher V, Concin N, Marth C, Tomovski C, et al. Plasma fibrinogen levels and prognosis in patients with ovarian cancer: a multicenter study. Oncologist. 2009;14:979–85.CrossRefPubMedGoogle Scholar
  19. 19.
    Azab B, Shah N, Radbel J, Tan P, Bhatt V, Vonfrolio S, et al. Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients. Med Oncol. 2013;30:432.CrossRefPubMedGoogle Scholar
  20. 20.
    He W, Yin C, Guo G, Jiang C, Wang F, Qiu H, et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol. 2013;30:439.CrossRefPubMedGoogle Scholar
  21. 21.
    Piver MS, Lele SB, Marchetti DL, Baker TR, Tsukada Y, Emrich LJ. The impact of aggressive debulking surgery and cisplatin-based chemotherapy on progression-free survival in stage III and IV ovarian carcinoma. J Clin Oncol. 1988;6:983–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.CrossRefPubMedGoogle Scholar
  23. 23.
    Makar AP, Baekelandt M, Trope CG, Kristensen GB. The prognostic significance of residual disease, FIGO substage, tumor histology, and grade in patients with FIGO stage III ovarian cancer. Gynecol Oncol. 1995;56:175–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23:265–73.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yildirim M, Yildiz M, Duman E, Goktas S, Kaya V. Prognostic importance of the nutritional status and systemic inflammatory response in non-small cell lung cancer. J Buon. 2013;18:728–32.PubMedGoogle Scholar
  26. 26.
    Dirican A, Kucukzeybek Y, Somali I, Erten C, Demir L, Can A, et al. The association of hematologic parameters on the prognosis of patients with metastatic renal cell carcinoma. J Buon. 2013;18:413–9.PubMedGoogle Scholar
  27. 27.
    Hong C, Wei Y, Jiang J, Zhao C, Liang G, Wang G, et al. Associations between lifestyles and neutrophil-lymphocyte and platelet-lymphocyte ratios in colorectal cancer. Asia Pac J Clin Oncol. 2013;10:168–74. doi: 10.1111/ajco.12080.Google Scholar
  28. 28.
    Garcea G, Ladwa N, Neal CP, Metcalfe MS, Dennison AR, Berry DP. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35:868–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Smith RA, Ghaneh P, Sutton R, Raraty M, Campbell F, Neoptolemos JP. Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio. J Gastrointest Surg. 2008;12:1422–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–6.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Allensworth SK, Langstraat CL, Martin JR, Lemens MA, McGree ME, Weaver AL, et al. Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer. Gynecol Oncol. 2013;130:499–504.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26:135–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Suzuki K, Aiura K, Ueda M, Kitajima M. The influence of platelets on the promotion of invasion by tumor cells and inhibition by antiplatelet agents. Pancreas. 2004;29:132–40.CrossRefPubMedGoogle Scholar
  34. 34.
    Riesco A. Five-year cancer cure: relation to total amount of peripheral lymphocytes and neutrophils. Cancer-Am Cancer Soc. 1970;25:135–40.Google Scholar
  35. 35.
    Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58:15–23.CrossRefPubMedGoogle Scholar
  36. 36.
    Wolff JP, de Oliveira CF. Lymphocytes in patients with ovarian cancer. Obstet Gynecol. 1975;45:656–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Yigit R, Massuger LF, Figdor CG, Torensma R. Ovarian cancer creates a suppressive microenvironment to escape immune elimination. Gynecol Oncol. 2010;117:366–72.CrossRefPubMedGoogle Scholar
  38. 38.
    Ruka W, Rutkowski P, Kaminska J, Rysinska A, Steffen J. Alterations of routine blood tests in adult patients with soft tissue sarcomas: relationships to cytokine serum levels and prognostic significance. Ann Oncol. 2001;12:1423–32.CrossRefPubMedGoogle Scholar
  39. 39.
    Shen GH, Ghazizadeh M, Kawanami O, Shimizu H, Jin E, Araki T, et al. Prognostic significance of vascular endothelial growth factor expression in human ovarian carcinoma. Br J Cancer. 2000;83:196–203.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Huang Y, Chen X, Dikov MM, Novitskiy SV, Mosse CA, Yang L, et al. Distinct roles of VEGFR-1 and VEGFR-2 in the aberrant hematopoiesis associated with elevated levels of VEGF. Blood. 2007;110:624–31.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Wei-wei Zhang
    • 1
    • 2
  • Ke-jun Liu
    • 3
  • Guo-lin Hu
    • 1
  • Wei-jiang Liang
    • 1
    Email author
  1. 1.Department of Medical Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.Department of Medical OncologyThe Sixth People’s Hospital of ChengduChengduChina
  3. 3.Department of Medical OncologyDongguan People’s HospitalDongguanChina

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