title: Preoperative Monocyte-to-Lymphocyte Ratio in Peripheral Blood Predicts Stages, Metastasis, and Histological Grades in Patients with Ovarian Cancer.
abstract: OBJECTIVE
  The monocyte-to-lymphocyte ratio (MLR) has been shown to be associated with the prognosis of various solid tumors. This study sought to evaluate the important value of the MLR in ovarian cancer patients.
  
  
  METHODS
  A total of 133 ovarian cancer patients and 43 normal controls were retrospectively reviewed. The patients' demographics were analyzed along with clinical and pathologic data. The counts of peripheral neutrophils, lymphocytes, monocytes, and platelets were collected and used to calculate the MLR, neutrophil-to-lymphocyte ratio (NLR). and platelet-to-lymphocyte ratio (PLR). The optimal cutoff value of the MLR was determined by using receiver operating characteristic curve analysis. We compared the MLR, NLR, and PLR between ovarian cancer and normal control patients and among patients with different stages and different grades, as well as between patients with lymph node metastasis and non-lymph node metastasis. We then investigated the value of the MLR in predicting the stage, grade, and lymph node positivity by using logistic regression. The impact of the MLR on overall survival (OS) was calculated by Kaplan-Meier method and compared by log-rank test.
  
  
  RESULTS
  Statistically significant differences in the MLR were observed between ovarian cancer patients and normal controls. However, no difference was found for the NLR and PLR. Highly significant differences in the MLR were found among patients with different stages (stage I-II and stage III-IV), grades (G1 and >G1), and lymph node metastasis status. The MLR was a significant and independent risk factor for lymph node metastasis, as determined by logistic regression. The optimal cutoff value of the MLR was 0.23. We also classified the data according to tumor markers (CA125, CA199, HE4, AFP, and CEA) and conventional coagulation parameters (International Normalized Ratio [INR] and fibrinogen). Highly significant differences in CA125, CA199, HE4, INR, fibrinogen levels, and lactate dehydrogenase were found between the low-MLR group (MLR ≤ 0.23) and the high-MLR group (MLR > 0.23). Correspondingly, dramatic differences were observed between the two groups in OS.
  
  
  CONCLUSIONS
  Our results show that the peripheral blood MLR before surgery could be a significant predictor of advanced stages, advanced pathologic grades, and positive lymphatic metastasis in ovarian cancer patients.
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China.
authors.forename: Jiangdong
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Bao
authors.affiliation: F1370016, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
authors.forename: Taizhong
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China. Electronic address: xixiaowei1966@126.com.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Xi
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China. Electronic address: heyinyan0228@126.com.
authors.forename: Yinyan
authors.initials: Y
authors.lastname: He
authors.affiliation: Shanghai First Maternity and Infant Hospital Corporation, Tongji University, Shanghai, 200126, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Wan