| Objective:This study through the retrospective analysis of 130 cases in our hospital diagnosed as the basic data and clinical prognosis of patients with ovarian cancer,discuss the preoperative prognostic nutritional index(Prognostic Nutritional Index PNI)and inflammatory markers(neutrophils/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)and lymphocyte ratio/mononuclear ratio(LMR))in ovarian cancer(Ovarian Cancer,OC)preoperative and postoperative prognosis value,in order to help making clinical decision and predicting prognosis of OC.Research Methodology:A total of 130 patients were admitted to the Department of Gynecology of the Second Hospital of Jilin University from December 2015 to March 2017.They were pathologically confirmed and first diagnosed with ovarian cancer.Basic case data and follow-up data of patients were collected for retrospective analysis.PNI and inflammatory markers were calculated by serum albumin,lymphocyte,neutrophil,platelet and monocyte counts in peripheral blood.The median is used to determine the critical value of PNI.All statistical analyses were performed using SPSS 26.0software(IBM Corp.,Armonk,NY,USA).The relationship between PNI and clinicopathological features was analyzed by t-test,chi-square test and nonparametric test.Survival distribution equilibrium was analyzed using log-rank test.PFS is calculated from the date of treatment initiation to the date of recurrence or progression.OS was calculated from the date of treatment initiation to the date of death or last follow-up.Kaplan-Meier method was used to estimate the cumulative survival curves and.The log-rank test was used to compare the survival curves.Multivariate Cox proportional risk regression was used to analyze the variables as independent predictors of PFS and OS,and the corresponding 95% confidence intervals(CI)were calculated.Med Calc software(version19.3.1;Med Calc Software bvba Ostend,Belgium)Compare the AUC value.A double-tailed P value <0.05 was considered statistically significant.Results:1.A total of 130 patients were included in this study,with the longest follow-up of 60 months and the shortest follow-up of 3 months.The median follow-up time was47 months.There were 123 cases(94.6%)of epithelial ovarian cancer and 7 cases(5.4%)of ovarian germ cell tumors.78 patients(60%)with ascites and 52 patients(40%)without ascites.FIGO staging included 61 patients(46.9%)in the early stage and 69 patients(53.1%)in the late stage.During the follow-up,67 patients(51.5%)had disease recurrence or progression,while 63 patients(48.5%)had no disease recurrence or progression.Fifty patients(38.5%)died,and 80 patients(61.5%)survived.A total of 107 patients(82.3%)received platinum-based chemotherapy,83patients(77.6%)were platinum-sensitive,and 24 patients(22.4%)were platinum-resistant.2.The median age of the included patients was 52 years(18-84years),CA125(315.31±257.65 U/m L),HE4(364.98±290.55 pmol/L),serum albumin(41.39±4.66g/L),neutrophils(5.03±2.40 109/L),lymphocyte count(1.58±0.78 109/L),monocyte c ount(0.46±0.19 109/L),and platelet count(286.93±94.30 109/L),PNI(49.5±6.00),NL R(3.07±3.10),PLR(190.5.±131.57)and LMR(3.33±1.85).The median values of PNI,NLR,PLR and LMR were49.50,3.07,190.50 and3.33,respectively.3.PNI was correlated with FIGO stage(P<0.001),CA125(P=0.003),NLR(P<0.0001),PLR(P<0.0001)and LMR(P<0.0001),but not with age(P=0.054),ascites(P=0.117)and HE4(P=0.079).4.The median PFS and OS were 42 months and 47 months,respectively.PFS was 26.5 months and OS was 36.9 months in low PNI group(<49.5);PFS was 37.7months and OS was 40.8 months in high PNI group(≥49.5).PFS of low PNI group was significantly lower than that of high PNI group(P=0.001),OS time of low PNI group was also significantly lower than that of high PNI group(P=0.008).Kaplan Meier analysis showed that PNI was correlated with PFS(log rank=8.881,P=0.003),and PNI was significantly correlated with OS(log rank=12.071,P=0.001).5.Univariate analysis of PNI and PFS showed that age,ascites,FIGO stage,CA125,HE4 and PNI were all correlated with PFS.Multivariate analysis showed no correlation between PNI(HR:0.780 95%CI:0.346-1.758 P=0.148)and the prognosis of PFS.FIGO stage(HR:4.179,19.150,85.901 95%CI:1.065-16.389,5.539-66.207,17.809-414.336 P<0.001)and ascites(HR:1.965 95%CI:1.016-3.800 P=0.045)were significantly associated with the prognosis of PFS.6.Univariate analysis of PNI and OS showed that age,ascites,FIGO stage,CA125 and PNI were correlated with OS.In multivariate analysis,PNI(HR:0.53495%CI:0.286-0.998 P=0.049)and FIGO staging(HR:2.497,15.323,60.197 95%CI:0.411-15.186,3.445-68.147,10.274-352.712 P<0.001)were associated with OS prognosis.7.Receiver operating characteristic curve(ROC)and area under receiver operating characteristic curve(AUC)were used to compare the predictive ability of CA-125,He-4 and PNI for PFS and OS.The AUC of PNI was lower than that of CA-125 and He-4(0.643,0.683 and0.693,respectively).The AUC of PNI was slightly higher than that of CA-125 and He-4(0.669,0.658and0.618,respectively),but the difference was not statistically significant(P>0.05).8.There was no correlation between PNI and PFS(HR:1.469 95%CI:0.412-5.233P=0.553)or OS(HR:1.429 95%CI:0.239-8.554 P=0.696)in univariate analysis of FIGO patients with early stage.9.Univariate analysis showed that PNI was not associated with PFS(P = 0.784)and OS(P = 0.627)in patients with advanced FIGO.10.PNI was negatively correlated with NLR(r=-0.555,P<0.001)and PLR(r=-0.609,P<0.001),and positively correlated with LMR(r = 0.590,P<0.001);PNI was negatively correlated with NLR(r=-0.404,P=0.001)and PLR(r=-0.561,P<0.001),and positively correlated with LMR(r=0.513,P<0.001)in early FIGO stage patients;PNI was negatively correlated with NLR(r=-0.533,P<0.001)and PLR(r=-0.535,P<0.001)in late FIGO stage patients 001)and LMR(r=0.535,P<0.001).11.Cox univariate analysis showed that age,ascites,FIGO stage,CA125,HE4 and PLR were all related to PFS,while NLR and LMR were not related to PFS.Multivariate analysis showed that PLR(HR 1.087 95%CI:0.610-1.938 P=0.777)was not an independent prognostic factor for PFS.Cox univariate analysis of patients’ OS found that PLR(HR:1.577 95%CI:0.899-2.372 P=0.112)was not significant.12.In this study,univariate analysis of NLR for COX of ovarian cancer showed that NLR was not correlated with PFS(HR 1.223 95%CI:0.751-1.991 P=0.418)and OS(HR 1.357 95%CI:0.776-2.372 P=0.285).13.LMR was not an independent prognostic factor for PFS(HR 0.687 95%CI:0.424-1.115 P=0.129)and OS(HR 0.642 95%CI: 0.368-1.119 P=0.118).Conclusions:1.Prognostic nutrition index(PNI)is not an independent prognostic factor for PFS in ovarian cancer patients,but FIGO stage and ascites can be an independent prognostic factor for PFS in ovarian cancer patients.High PNI and FIGO stage were independent prognostic factors for OS in ovarian cancer patients.2.The AUC value of PNI was lower than that of CA-125 and HE-4 in predicting the recurrence or progression rate of ovarian cancer.The AUC value of PNI was slightly higher than that of CA-125 and HE-4 in predicting mortality,but the difference was not statistically significant.3.According to FIGO stage,patients were divided into early and advanced stages for stratified analysis.We found that PNI was not correlated with the prognosis of PFS and OS in early and advanced ovarian cancer patients.4.In the study of the correlation between PNI and inflammatory markers,it was found that PNI was negatively correlated with NLR and PLR and positively correlated with LMR both in the whole and in the early and late stage of FIGO.This shows that the decrease of PNI in patients with OC is closely related to enhanced systemic inflammatory markers,which can reflect the level of inflammation in patients with OC.5.NLR,PLR and LMR were not correlated with the prognosis of PFS and OS. |
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