title: Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses.
abstract: OBJECTIVE
  We aimed to investigate the utility of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count as biomarkers to distinguish malignant from benign ovarian masses.
  
  
  METHODS
  We retrospectively reviewed the histopathological results of 185 benign and 33 malignant cases following surgery for an initial diagnosis of adnexal mass and confirmed ovarian masses. Age, cancer antigen 125 (CA-125), white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), mean platelet volume (MPV), platelet distribution width (PDW), NLR, PLR, and lymphocyte counts were compared between groups.
  
  
  RESULTS
  The significant diagnostic factors to distinguish malignant from benign disease were age (35.5±22 vs. 62±13 years; p<0.001) and CA-125 levels (16.6±21 vs. 98±366 U/mL; p<0.001). No significant difference was observed in WBC count, Hct, Hb, platelet count, PDW, and MPV between groups. To distinguish malignant from benign masses, lymphocyte count (1.29±0.91 vs. 1.80±0.67×10(3) cells/μL, p<0.001), NLR (4.95±5.36 vs. 3.32±2.72, p=0.024), and PLR (203.41±107.84 vs. 160.75±70.84, p<0.001) were identified as markers. The cutoff values were lymphocyte count of >1500 cells/μL (p<0.001), NLR of 3.4732 (p=0.033), PLR of 161.13 (p<0.001), CA-125 of >40 U/mL (p<0.001), and age of >53 years (p<0.001); their respective sensitivity and specificity were 66.7% and 77.8% [area under the curve (AUC), 0.723±0.055], 68.8% and 54.1% (AUC, 0.624±0.058), 81.8% and 50.8% (AUC, 0.683±0.052), 78.8% and 77.8% (AUC, 0.797±0.057), and 81.8% and 82.2% (AUC, 0.888±0.025). Multiple logistic regression analysis revealed cutoff explanatory and accuracy values of 68.2% and 94.9%, respectively, for lymphocyte count, NLR, PLR, CA-125, and age as independent parameters to distinguish malignant from benign ovarian masses.
  
  
  CONCLUSIONS
  In combination with age and CA-125 levels, NLR, PLR, and lymphocyte count may be helpful to preoperatively distinguish malignant from benign ovarian masses.
authors.affiliation: Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Bakacak
authors.affiliation: Clinic of Obstetrics and Gynecology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Serin
authors.affiliation: Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
authors.forename: Önder
authors.initials: Ö
authors.lastname: Ercan
authors.affiliation: Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Köstü
authors.affiliation: Clinic of Obstetrics and Gynecology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Mehmet Sühha
authors.initials: MS
authors.lastname: Bostancı
authors.affiliation: Clinic of Obstetrics and Gynecology, Private Caka Vatan Hospital, Kahramanmaraş, Turkey.
authors.forename: Zeyneb
authors.initials: Z
authors.lastname: Bakacak
authors.affiliation: Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Kıran
authors.affiliation: Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
authors.forename: Gürkan
authors.initials: G
authors.lastname: Kıran
keywords: Neutrophil-to-lymphocyte ratio; benign ovarian mass; malignant ovarian mass; platelet-to-lymphocyte ratio