Clinical and Translational Oncology

, Volume 18, Issue 5, pp 457–463 | Cite as

Neutrophil to lymphocyte and platelet to lymphocyte ratios increase in ovarian tumors in the presence of frank stromal invasion

  • M. Polat
  • T. Senol
  • E. OzkayaEmail author
  • G. Ogurlu Pakay
  • M. S. Cikman
  • B. Konukcu
  • M. A. Ozten
  • A. Karateke
Research Article



The aim of this study was to assess the predictive value of neutrophil/lymphocyte and platelet/lymphocyte ratios for borderline, malignant ovarian tumors, and borderline cases with microinvasion.


Totally 275 women with sonographically detected ovarian tumor were enrolled for this study. All subjects underwent gynecological surgery via endoscopic or conventional approach and ovarian masses were all evaluated histopathologically by the same pathologist. All study population was divided into three groups as group with borderline tumors, benign tumors, or malignant tumors according to the histopathological diagnosis. Just before surgical intervention, a blood sample was obtained from each participant to analyze CA125 level, neutrophil, platelet, and lymphocyte count.


Neutrophil/lymphocyte ratio (AUC = 0.604, P = 0.02) was a significant predictor for malignant cases. Optimal cutoff value for the neutrophil/lymphocyte ratio was found to be 2.47 with 63.4 % sensitivity and 63.5 % specificity for malignancy prediction. Odds ratio of high neutrophil/lymphocyte ratio for malignancy risk was 2.5 (95 % CI 1.3–4.8, P = 0.004). Platelet/lymphocyte ratio (AUC = 0.621, P = 0.007) was a significant predictor for malignant cases. Platelet/lymphocyte ratio (AUC = 0.568, P = 0.05) was also predictive for cases without a benign mass. Optimal cutoff value for the platelet/lymphocyte ratio was found to be 144.3 with 54 % sensitivity and 59 % specificity for malignancy prediction. Odds ratio of high platelet/lymphocyte ratio for malignancy risk was 2.1 (95 % CI 1.1–3.8, P = 0.02).


Neutrophil/lymphocyte and platelet/lymphocyte ratios are predictors for malignant ovarian tumors but not borderline tumors even in case of microinvasion.


Ovarian cancer Neutrophil to lymphocyte ratio Platelet to lymphocyte ratio Tumor diameter CA125 Borderline tumor 



We would like to thank all the patients and primary care physicians.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Signed informed consent was obtained from all the participants.

This study complies with the latest Declaration of Helsinki for Researches involving Human Participants and/or Animals.


  1. 1.
    Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and can-cer. Cell. 2010;140(6):883–99.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    O’Callaghan DS, O’Donnell D, O’Connell F, O’Byrne KJ. The role of inflammation in the pathogenesis of non-small cell lung cancer. J Thorac Oncol. 2010;5(12):2024–36.CrossRefPubMedGoogle Scholar
  3. 3.
    Aggarwal BB, Vijayalekshmi RV, Sung B. Targeting inflammatory pathways for prevention and therapy of cancer: short-term friend, long-term foe. Clin Cancer Res. 2009;15(2):425–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Viganó A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME. Clinical survival predictors in patients with advanced cancer. Arch Intern Med. 2000;160(6):861–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134(10):2403–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Akın MN, Harmandar Kasap B, Uslu Yuvacı H. Neutrophil-to-lymphocyte ratio and platelet distribution in patients with endometrial cancer. J Obstet Gynaecol Res. 2015. doi: 10.1111/jog.12723.PubMedGoogle Scholar
  8. 8.
    Yildirim M. Demir Cendek B, Filiz Avsar A. Differentiation between benign and malignant ovarian masses in the preoperative period using neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Mol Clin Oncol. 2015;3(2):317–21.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Karlsen MA, Sandhu N, Høgdall C, Christensen IJ, Nedergaard L, Lundvall L, et al. Evaluation of HE4, CA125, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2012;127(2):379–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Bast RC Jr, Skates S, Lokshin A, Moore RG. Differential diagnosis of a pelvic mass: improved algorithms and novel biomarkers. Int J Gynecol Cancer. 2012;22(Suppl 1):S5–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.CrossRefPubMedGoogle Scholar
  12. 12.
    de Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer. 2006;6:24–37.CrossRefPubMedGoogle Scholar
  13. 13.
    Shappell HW, Riopel MA, Smith Sehdev AE, Ronnett BM, Kurman RJ. Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. Am J Surg Pathol. 2002;26(12):1529–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. doi: 10.1093/jnci/dju124.CrossRefPubMedGoogle Scholar
  15. 15.
    Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol. 2014;23(1):31–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Yildirim MA, Seckin KD, Togrul C, Baser E, Karsli MF, Gungor T, et al. HC. Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses. Asian Pac J Cancer Prev. 2014;15(16):6881–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Topcu HO, Guzel AI, Ozer I, Kokanali MK, Gokturk U, Muftuoglu KH, et al. Comparison of neutrophil/lymphocyte and platelet/lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice. Asian Pac J Cancer Prev. 2014;15(15):6239–41.CrossRefPubMedGoogle Scholar
  19. 19.
    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(7):499–503.CrossRefPubMedGoogle Scholar
  20. 20.
    Szalayova G, James TA, Rincon M. A framework for the role of acute inflammation in tumor progression. Breast Cancer Res Treat. 2015;151(2):235–8.CrossRefPubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • M. Polat
    • 1
  • T. Senol
    • 1
  • E. Ozkaya
    • 1
    Email author
  • G. Ogurlu Pakay
    • 1
  • M. S. Cikman
    • 1
  • B. Konukcu
    • 1
  • M. A. Ozten
    • 1
  • A. Karateke
    • 1
  1. 1.Department of Obstetrics and GynecologyZeynep Kamil Women and Children’s Health Training and Research HospitalÜsküdar/IstanbulTurkey

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