International Journal of Clinical Oncology

, Volume 23, Issue 1, pp 104–113 | Cite as

Comparison of clinical utility between neutrophil count and neutrophil–lymphocyte ratio in patients with ovarian cancer: a single institutional experience and a literature review

  • Naoko Komura
  • Seiji Mabuchi
  • Eriko Yokoi
  • Katsumi Kozasa
  • Hiromasa Kuroda
  • Tomoyuki Sasano
  • Yuri Matsumoto
  • Tadashi Kimura
Original Article



We retrospectively investigated the prognostic significance and clinical utility of pretreatment neutrophilia and elevated neutrophil–lymphocyte ratio (NLR) in patients with epithelial ovarian cancer.


Clinical data were collected from 344 surgically staged ovarian cancer patients between April 2007 and March 2016 and retrospectively reviewed. Neutrophilia and elevated NLR were defined as a neutrophil count ≥ 8,000/μl and an NLR ≥ 4.0, respectively. Univariate or multivariate analysis was conducted to evaluate the association between pretreatment neutrophilia or elevated NLR and clinicopathological characteristics, optimal surgery rate, progression-free survival (PFS) and disease-specific survival (DSS). Finally, we compared the clinical utility between neutrophil count and NLR by receiver operating characteristic (ROC) analysis.


Pretreatment neutrophilia and elevated NLR were observed in 24 (7.0%) and 142 (41.3%) patients, respectively. In univariate analysis, both neutrophilia and elevated NLR were found to be associated with short PFS and DSS (p < 0.005). Multivariate analysis showed that neutrophilia and elevated NLR were predictors for shorter survival. In ROC analysis, the NLR tended to have a greater area under the ROC curve (AUC) value than the neutrophil count in predicting recurrence (0.7011 vs 0.6516, p = 0.0546) and had a significantly greater AUC value in predicting DSS (0.7249 vs 0.6379, p = 0.0182). Finally, based on the neutrophil count and NLR, we divided the patients into 3 prognostic groups—high-risk group (elevated NLR with neutrophilia), intermediate-risk group (elevated NLR without neutrophilia), and low-risk group (normal NLR), which allows for individualized and accurate survival estimates.


Pretreatment neutrophilia and elevated NLR are independent poor prognostic factors in epithelial ovarian cancer patients. The NLR was superior to neutrophil count in predicting the survival of epithelial ovarian cancer patients.


Ovarian cancer Neutrophilia Neutrophil–lymphocyte ratio Survival 


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

10147_2017_1180_MOESM1_ESM.pptx (41 kb)
Fig. 1 Kaplan–Meier estimates of DSS based on pretreatment NLR (NLR < 2.0, 2.0 ≤ NLR < 4.0, 4.0 ≤ NLR < 10.0, 10.0 ≤ NLR). A greater absolute value of NLR was associated with shorter survival. Group 1 versus group 2; p = 0.0203 (log-rank), group 1 versus group 3; p < 0.0001 (log-rank), group 1 versus group 4; p < 0.0001 (log-rank), group 2 versus group 3; p = 0.0010 (log-rank), group 2 versus group 4; p < 0.0001 (log-rank), group 3 versus group 4; p = 0.0526 (log-rank) (PPTX 41 kb)


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Naoko Komura
    • 1
  • Seiji Mabuchi
    • 1
  • Eriko Yokoi
    • 1
  • Katsumi Kozasa
    • 1
  • Hiromasa Kuroda
    • 1
  • Tomoyuki Sasano
    • 1
  • Yuri Matsumoto
    • 1
  • Tadashi Kimura
    • 1
  1. 1.Department of Obstetrics and GynecologyOsaka University Graduate School of MedicineSuitaJapan

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