Kwon Byung Su, Jeong Dae Hoon, Byun Jung Mi, Lee Tae Hwa, Choi Kyung Un, Song Yong Jung, Suh Dong Soo, Kim Ki Hyung
Department of Obstetrics and Gynecology, Pusan National University School of Medicine, and Biomedical Research Institute and Pusan Cancer Center, Pusan National University Hospital, Busan, South Korea.
Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan, South Korea.
J Cancer. 2018 Mar 8;9(7):1127-1134. doi: 10.7150/jca.24057. eCollection 2018.
The aim of the present study was to determine the prognostic significances of markers of preoperative systemic inflammatory response (SIR) in patients with ovarian clear cell carcinoma (OCCC). A total of 109 patients diagnosed with OCCC that underwent primary cytoreductive surgery and adjuvant platinum-based chemotherapy from 2009 to 2012 were enrolled in this retrospective study. SIR markers were calculated from complete blood cell counts determined before surgery. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). Prognostic significances with respect to overall survival (OS) and progression-free survival (PFS) were determined by Kaplan-Meier curve and multivariate Cox regression analysis. The optimized NLR, LMR and PLR cut-off values as determined by ROC curve analysis for PFS and OS were 2.3, 4.2, and 123.6, respectively. When the cohort was divided using these optimized cut-offs, NLR and LMR were found to be significantly associated with clinicopathologic factors, NLR with FIGO stage, the presence of malignant ascites, and platinum response, and LMR with FIGO stage, lymph node metastasis, malignant ascites, and platinum response. Kaplan-Meier analysis revealed a high NLR (> 2.3) was significantly associated with low 5-year PFS and OS rates and that a high LMR was significantly associated with high 5-year PFS and OS rates. Multivariate analysis identified FIGO stage, residual mass, and platinum response as independent prognostic factors of PFS, and FIGO stage, residual mass, platinum response, and LMR as independent prognostic factors of OS. Markers of systemic inflammatory response provide useful prognostic information and lymphocyte-to-monocyte ratio is the most reliable independent prognostic factor of overall survival in patients with ovarian clear cell carcinoma.
本研究的目的是确定术前全身炎症反应（SIR）标志物在卵巢透明细胞癌（OCCC）患者中的预后意义。本回顾性研究纳入了2009年至2012年期间共109例诊断为OCCC并接受了初次肿瘤细胞减灭术和铂类辅助化疗的患者。SIR标志物通过术前全血细胞计数计算得出。采用受试者工作特征（ROC）曲线分析来确定中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）和血小板与淋巴细胞比值（PLR）的最佳临界值。通过Kaplan-Meier曲线和多因素Cox回归分析确定总生存（OS）和无进展生存（PFS）的预后意义。ROC曲线分析确定的PFS和OS的优化NLR、LMR和PLR临界值分别为2.3、4.2和123.6。当使用这些优化临界值对队列进行划分时，发现NLR和LMR与临床病理因素显著相关，NLR与国际妇产科联盟（FIGO）分期、恶性腹水的存在以及铂类反应相关，LMR与FIGO分期、淋巴结转移、恶性腹水和铂类反应相关。Kaplan-Meier分析显示，高NLR（>2.3）与低5年PFS和OS率显著相关，高LMR与高5年PFS和OS率显著相关。多因素分析确定FIGO分期、残留肿块和铂类反应为PFS的独立预后因素，FIGO分期、残留肿块、铂类反应和LMR为OS的独立预后因素。全身炎症反应标志物提供了有用的预后信息，淋巴细胞与单核细胞比值是卵巢透明细胞癌患者总生存最可靠的独立预后因素。
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