The prognostic significance of preoperative leukocytosis in epithelial ovarian carcinoma: a retrospective cohort study.
OBJECTIVE
Preoperative leukocytosis is known to be a negative prognostic factor for several gynecologic malignancies, but its relationship with epithelial ovarian carcinoma (EOC) is unknown. We sought to evaluate the prognostic implications of preoperative leukocytosis for women with EOC.


METHODS
We retrospectively reviewed the medical records of patients who underwent primary debulking surgery and adjuvant platinum-based chemotherapy for EOC between January 1993 and October 2011. Associations between leukocytosis and recurrence-free survival (RFS) and overall survival (OS) were determined by univariate analyses. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors for RFS and OS.


RESULTS
Of 155 women, 23 (14.8%) had leukocytosis and 132 (85.2%) did not have leukocytosis. RFS and OS were significantly shorter for women with leukocytosis than for women without leukocytosis (P=0.009 and P<0.0001, respectively). The mortality rate was also higher among women with leukocytosis (P<0.0001). Multivariate analysis revealed that preoperative leukocytosis (hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.55-4.41; P=0.009), advanced stage (HR: 3.12; 95% CI: 1.44-6.75; P=0.004), and optimal cytoreduction (HR: 0.38; 95% CI: 0.14-0.70; P=0.031) were independent prognostic factors for RFS. Additionally, preoperative leukocytosis was independently associated with decreased OS (HR: 7.66; 95% CI: 2.78-21.16; P<0.0001).


CONCLUSIONS
Among women with EOC, preoperative leukocytosis might be an independent prognostic factor for RFS and OS. A larger-scaled, prospective study is needed to verify these results.
Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Kyeong A
KA
So
Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea. Electronic address: jhhong93@korea.ac.kr.
Jin Hwa
JH
Hong
Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Hye Mi
HM
Jin
Department of Obstetrics and Gynecology, Ansan Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Jae Won
JW
Kim
Department of Obstetrics and Gynecology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Jae Yun
JY
Song
Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Jae Kwan
JK
Lee
Department of Obstetrics and Gynecology, Ansan Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Nak Woo
NW
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
D016190:Carboplatin; D017239:Paclitaxel
Leukocytosis; Ovarian cancer; Overall survival; Recurrence-free survival