title: Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer.
abstract: OBJECTIVE
  To determine whether level of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) was a prognostic indicator for epithelial ovarian cancer (EOC) patient. The present study further aimed to evaluate the impact of the change of preoperative/postoperative NLR on the survival.
  
  
  METHODS
  Medical records of the patients undergoing an operation for EOC in Vajira Hospital between January 1, 2004 and December 31, 2009 were reviewed. Demographic, clinicopathological, and laboratory data were assessed. Preoperative NLR level was divided into high (more than 2.6) and low (2.6 or less) groups and their association with survival were determined. The survival of the subjects according to their preoperative NLR compared to postoperative level was also evaluated.
  
  
  RESULTS
  Mean age of 129 subjects was 49.6 +/- 12.5 years. Median pre- and post-operative NLR were 2.8 (range 0.86 to 30.0) and 2.7 (range 0.16 to 31.3), respectively. Seventy-one patients (55.0%) had high preoperative NLR and 64 (53.8%) had high postoperative value. High preoperative and pre- and post-operative NLR were significantly associated with advanced stage and suboptimal surgery. While high post-operative NLR was significantly associated with advanced stage but not suboptimal surgery. In univariable analysis, preoperative/postoperative high/high NLR tended to associate with poor progression free survival (PFS) but not overall survival (OS), with p = 0.019 and p = 0.052 respectively. By multivariable analysis, the advanced stage and suboptimal surgery, but not preoperative and postoperative NLR, were independent poor prognostic factors for PFS and OS.
  
  
  CONCLUSIONS
  The level of preoperative NLR and the change of preoperative/postoperative NLR level tended to associate with PFS more than OS of EOC patient.
authors.affiliation: Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand. thavalai@hotmail.com
authors.forename: Thaovalai
authors.initials: T
authors.lastname: Thavaramara
authors.forename: Chadakarn
authors.initials: C
authors.lastname: Phaloprakarn
authors.forename: Siriwan
authors.initials: S
authors.lastname: Tangjitgamol
authors.forename: Sumonmal
authors.initials: S
authors.lastname: Manusirivithaya
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D013509:Gynecologic Surgical Procedures; D006784:Hospitals, Teaching; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000145:classification / Q000473:pathology* / Q000601:surgery; D009504:Neutrophils / Q000166:cytology*; D010051:Ovarian Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D016019:Survival Analysis; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor