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

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Abstract

Objective

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

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Jayson GC, Kohn EC, Kitchener HC et al (2014) Ovarian cancer. Lancet 384(9951):1376–1388

    Article  PubMed  Google Scholar 

  2. Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  PubMed  Google Scholar 

  3. SEER Cancer Statistics Review (CSR) 1975-2014. National Cancer Institute. Available via DIALOG. https://seer.cancer.gov/csr/1975_2014/sections.html of subordinate document. Accessed June 2017

  4. Heintz AP, Odicino F, Maisonneuve P et al (2006) Carcinoma of the ovary. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95(Suppl 1):S161–S192

    Article  PubMed  Google Scholar 

  5. Li MX, Liu XM, Zhang XF et al (2014) Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 134(10):2403–2413

    Article  CAS  PubMed  Google Scholar 

  6. Yang JJ, Hu ZG, Shi WX et al (2015) Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: a meta-analysis. World J Gastroenterol 21(9):2807–2815

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yin Y, Wang J, Wang X et al (2015) Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: a meta-analysis. Clinics 70(7):524–530

    Article  PubMed  PubMed Central  Google Scholar 

  8. Xin-Ji Z, Yong-Gang L, Xiao-Jun S et al (2015) The prognostic role of neutrophils to lymphocytes ratio and platelet count in gastric cancer: a meta-analysis. Int J Surg 21:84–91

    Article  PubMed  Google Scholar 

  9. Tang L, Li X, Wang B et al (2016) Prognostic value of neutrophil-to-lymphocyte ratio in localized and advanced prostate cancer: a systematic review and meta-analysis. PLoS One 11(4):e-153981

    Google Scholar 

  10. Hu K, Lou L, Ye J et al (2015) Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis. BMJ Open 5(4):e006404

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wei B, Yao M, Xing C et al (2016) The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis. Onco Targets Ther 9:5567–5575

    Article  PubMed  PubMed Central  Google Scholar 

  12. Coffelt SB, Wellenstein MD, de Visser KE (2016) Neutrophils in cancer: neutral no more. Nat Rev Cancer 16(7):431–446

    Article  CAS  PubMed  Google Scholar 

  13. Gentles AJ, Newman AM, Liu CL et al (2015) The prognostic landscape of genes and infiltrating immune cells across human cancers. Nat Med 21(8):938–945

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Bishara S, Griffin M, Cargill A et al (2008) Pre-treatment white blood cell subtypes as prognostic indicators in ovarian cancer. Eur J Obstet Gynecol Reprod Biol 138(1):71–75

    Article  CAS  PubMed  Google Scholar 

  15. Cho H, Hur HW, Kim SW et al (2009) Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 58(1):15–23

    Article  CAS  PubMed  Google Scholar 

  16. Asher V, Lee J, Innamaa A et al (2011) Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol 13(7):499–503

    Article  PubMed  Google Scholar 

  17. Thavaramara T, Phaloprakarn C, Tangjitgamol S et al (2011) Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer. J Med Assoc Thai 94(7):871–877

    PubMed  Google Scholar 

  18. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S et al (2012) Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol 23(4):265–273

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang WW, Liu KJ, Hu GL et al (2015) Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients. Tumour Biol 36(11):8831–8837

    Article  CAS  PubMed  Google Scholar 

  20. Wang YQ, Jin C, Zheng HM et al (2016) A novel prognostic inflammation score predicts outcomes in patients with ovarian cancer. Clin Chim Acta 456:163–169

    Article  CAS  PubMed  Google Scholar 

  21. Feng Z, Wen H, Bi R, Ju X et al (2016) Preoperative neutrophil-to-lymphocyte ratio as a predictive and prognostic factor for high-grade serous ovarian cancer. PLoS One 11(5):e0156101

    Article  PubMed  PubMed Central  Google Scholar 

  22. Paik ES, Shim M, Choi HJ et al (2016) Preoperative multiplication of neutrophil and monocyte counts as a prognostic factor in epithelial ovarian cancer. Cancer Biomark 17(4):419–425

    Article  CAS  PubMed  Google Scholar 

  23. Miao Y, Yan Q, Li S et al (2016) Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemotherapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark 17(1):33–40

    Article  CAS  PubMed  Google Scholar 

  24. Badora-Rybicka A, Nowara E, Starzyczny-Słota D (2016) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio before chemotherapy as potential prognostic factors in patients with newly diagnosed epithelial ovarian cancer. ESMO Open 1(2):e000039

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang Y, Liu P, Xu Y et al (2015) Preoperative neutrophil-to-lymphocyte ratio predicts response to first-line platinum-based chemotherapy and prognosis in serous ovarian cancer. Cancer Chemother Phamacol 75(2):255–262

    Article  CAS  Google Scholar 

  26. Kim HS, Choi HY, Lee M et al (2016) Systemic inflammatory response markers and CA-125 levels in ovarian clear cell carcinoma: a two center cohort study. Cancer Res Treat 48(1):250–258

    Article  CAS  PubMed  Google Scholar 

  27. Zhao W, Wang P, Jia H et al (2017) Neutrophilcount and percentage: potential independent prognostic indicators for advancedcancer patients in a palliative care setting. Oncotarget 38(8):64499–64508

    Google Scholar 

  28. Templeton AJ, McNamara MG, Šeruga B et al (2014) Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 106(6):dju124

    Article  PubMed  Google Scholar 

  29. Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91(3):181–184

    Article  CAS  PubMed  Google Scholar 

  30. Milne K, Alexander C, Webb JR et al (2014) Absolute lymphocyte count is associated with survival in ovarian cancer independent of tumor-infiltrating lymphocytes. J Transl Med 10:33

    Article  Google Scholar 

  31. Santoiemma PP, Powell DJ Jr (2015) Tumor infiltrating lymphocytes in ovarian cancer. Cancer Biol Ther 16(6):807–820

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Li J, Wang J, Chen R, Bai Y, Lu X (2017) The prognostic value of tumor-infiltrating T lymphocytes in ovarian cancer. Oncotarget 8(9):15621–15631

    PubMed  PubMed Central  Google Scholar 

  33. Mabuchi S, Matsumoto Y, Kawano M et al (2014) Uterine cervical cancer displaying tumor-related leukocytosis: a distinct clinical entity with radioresistant feature. J Natl Cancer Inst 106(7):dju147

    Article  PubMed  Google Scholar 

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Correspondence to Seiji Mabuchi.

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10147_2017_1180_MOESM1_ESM.pptx

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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Komura, N., Mabuchi, S., Yokoi, E. et al. Comparison of clinical utility between neutrophil count and neutrophil–lymphocyte ratio in patients with ovarian cancer: a single institutional experience and a literature review. Int J Clin Oncol 23, 104–113 (2018). https://doi.org/10.1007/s10147-017-1180-4

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  • DOI: https://doi.org/10.1007/s10147-017-1180-4

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