The Relationship Between Preoperative Blood Lymphocyte-tomonocyte Ratio And The Prognostic Of Epithelial Ovarian Cancer

BackgroundOvarian cancer is one of the three malignant tumors of female reproductive system,and its mortality is the first in female reproductive system malignant tumors.Epithelial ovarian cancer accounts for about 85% to 90% of ovarian cancer,and is the main research direction of ovarian cancer.Because the ovary is located deep in the pelvic cavity,there is no obvious clinical symptoms in the early stage and lack of early screening.Therefore,about 70% to 80% of the patients have been in the advanced stage of the disease.The prognosis of patients with advanced epithelial ovarian cancer is still poor,despite the continuous improvement in surgical procedures and the continuous updating of chemotherapeutic agents.Therefore,exploring the corresponding clinical indicators that can predict the prognosis,optimizing clinical decisions,improving patient survival and quality of life,is the current research hotspot of epithelial ovarian cancer.In recent years,many studies have focused on the prognostic value of haematological components of systemic inflammatory response to solid tumors.Lymphocytes are a major component of the human immune system.As another major regulator of cancer and inflammation-tumor associated monocytes have also been shown to play an important role in the systemic inflammatory response of tumors.The lymphocyte/monocyte ratio(LMR)has been shown to be associated with survival in patients with malignant lymphoma and many solid tumors,such as the head and neck,breast,lung,gastrointestinal,urogenital,and cancer.But LMR has little research on ovarian cancer.ObjectiveTo measure the prognostic value of the lymphocyte-monocyte ratio(LMR)in patients with epithelial ovarian cancer(EOC).MethodA retrospective cohort of 240 patients who were newly diagnosed EOC and underwent surgical resection was recruited between January 2000 and December 2013,which collected from the First Affiliated hospital of Zhengzhou University.Patients were categorized into two different groups based on the LMR,LMR-low)and LMR-high,using cut-off values determined by receiver operating characteristic(ROC)curve analysis.The clinicopathological characteristics and survivals between the two groups were compared byχ2 Test and Log-Rank Test.Multivariate COX proportional hazards analyses were applied to validate the LMR as an independent predictor of survival Results1.Using the data collected from the whole cohort,the optimized LMR cut-off value selected on the ROC curve was 3.949 for the OS.2.The pretreatment LMR differed significantly in the International Federation of Gynecology and Obstetrics(FIGO)stage,CA-125 level and Lactate dehydrogenase(LDH)level between the low LMR group and the high LMR group(P = 0.000,P=0.000,and P=0.002,respectively),but no discrimination was observed in age,histologic type and grade(P = 0.371,P=0.569,and P=0.379,respectively).3.Univariate analysis revealed that age(>56),LMR≤3.949,FIGO III~IV,pathological type(mucinous carcinoma)and advanced tumor stage were associated with poor OS(P = 0.003,P=0.013,P=0.001,P=0.002 and P=0.028,respectively).4.On multivariate analysis,we identified FIGO stage(hazard ratio or HR = 0.462,95% confidence interval or 95% CI=0.274~0.650,P=0.010)and the LMR(hazard ratio or HR=1.989,95% confidence interval or 95% CI=1.181~3.349;P=0.028)as a significantly independent predictor for OS.Conclusion1.The reduced pretreatment peripheral LMR level is associated with late stage and elevated CA-125 in patients with epithelial ovarian cancer,which may indicate tumor progression and may serve as a basis for clinical diagnosis and treatment decisions.2.Except for FIGO staging,the reduced pretreatment peripheral LMR level indicates poor prognosis in patients with EOC and may function as an important independent prognostic factor affecting the survival of patients with EOC.