Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer.
OBJECTIVE
To investigate the neutrophil-to-lymphocyte ratio (NLR) from peripheral blood, a general measure of inflammation, in ovarian cancer.


METHODS
White cell counts and CA125 levels before treatment, tumor features, and questionnaire data on 519 women with ovarian cancer at two Boston hospitals were recorded. Counts were log-transformed and effects on these by tumor features and epidemiologic variables assessed by analysis of variance and generalized linear models. Cox proportional hazards models were used to assess effects on overall survival.


RESULTS
Greater NLR was associated with higher tumor stage and grade, presence of ascites, and bilateral disease and correlated with risk factors including Jewish ethnicity, taller height, more ovulatory cycles, and family history of cancer in premenopausal women and talc use in all women. CA125 was positively correlated with neutrophil count, monocyte count, and NLR and inversely correlated with lymphocyte count. In a multivariate adjusted analysis, high NLR predicted poorer survival and high lymphocyte count better survival.


CONCLUSIONS
An elevated NLR before treatment signals more aggressive disease and correlates with risk factors for ovarian cancer. CA125 directly correlates with neutrophils which may reflect secretion of both CA125 and neutrophilic growth factors by the tumor. CA125 inversely correlates with lymphocytes which may reflect the ability of some neutrophilic factors to induce lymphopenia and/or binding of CA125 to lymphocytes removing CA125 from the serum pool. Links between NLR, CA125, and epidemiologic factors may provide new clues about the pathogenesis and progression of ovarian cancer.
Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA; Harvard Medical School, 260 Longwood Avenue, Boston, MA 02115, USA.
Kristina A
KA
Williams
Dana Farber Cancer Institute, 44 Binney Street, Boston, MA, USA.
S Intidhar
SI
Labidi-Galy
Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA; Harvard Medical School, 260 Longwood Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Kathryn L
KL
Terry
Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA.
Allison F
AF
Vitonis
Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
William R
WR
Welch
Harvard Medical School, 260 Longwood Avenue, Boston, MA 02115, USA; Gillette Center for Women's Cancer, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Annekathryn
A
Goodman
Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA; Harvard Medical School, 260 Longwood Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address: dcramer@partners.org.
Daniel W
DW
Cramer
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000097:blood*
D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
CA125; Ovarian cancer; Risk factors