title: Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio before chemotherapy as potential prognostic factors in patients with newly diagnosed epithelial ovarian cancer.
abstract: BACKGROUND
  Recent studies have shown that the presence of systemic inflammation correlates with worse outcomes in many types of cancers. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed as indicators of systemic inflammatory response. The aim of the study was to assess the prognostic value of NLR and PLR before starting chemotherapy among patients with newly diagnosed ovarian cancer.
  
  
  METHODS
  We conducted a retrospective analysis of medical documentation of 315 patients with newly diagnosed epithelial ovarian cancer, treated in Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, between 2007 and 2013. 31 (12.1%) patients had metastatic disease at the time of diagnosis. Receiver-operating characteristic (ROC) curves for progression free survival (PFS) and overall survival (OS) prediction were plotted to verify cut-off points for NLR and PLR. PFS and OS were analysed for correlation with NLR and PLR, using the Cox regression model. Other potential prognostic variables included in multivariate analysis were: patient's age at diagnosis (<65 vs ≥65 years), Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2, FIGO stage of the disease and baseline Ca-125 level.
  
  
  RESULTS
  In multivariate analysis, higher pretreatment NLR (p=0.002), poor ECOG-PS (p=0.0002), higher disease stage (p<0.0001) and baseline Ca-125 (p=0.03) level were independent negative prognostic factors for PFS. However, only ECOG-PS ≥2 (p<0.0001), high stage of the disease (p<0.0001) and high baseline Ca-125 level (p=0.0003) were independent negative prognostic factors for OS.
  
  
  CONCLUSIONS
  Advanced stage of the disease with high Ca-125 level and poor patient performance status are the most important prognostic factors in ovarian cancer. Higher pretreatment value of NLR was an independent negative prognostic factor for PFS, with no significant impact on OS.
authors.affiliation: Clinical and Experimental Oncology Department , Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch , Gliwice , Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Badora-Rybicka
authors.affiliation: Clinical and Experimental Oncology Department , Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch , Gliwice , Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Nowara
authors.affiliation: Clinical and Experimental Oncology Department , Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch , Gliwice , Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Starzyczny-Słota
keywords: neutrophil-to-lymphocyte ratio; ovarian cancer; platelet-to-lymphocyte ratio