Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
Int J Gynecol Cancer. 2020 Sep;30(9):1378-1383. doi: 10.1136/ijgc-2020-001378. Epub 2020 Aug 11.
The preoperative neutrophil-to-lymphocyte ratio has been found to be an independent prognostic indicator for perioperative complications and survival outcomes in patients undergoing oncologic surgery for several malignancies. The objective of this study was to evaluate the role of the preoperative neutrophil-to-lymphocyte ratio in predicting 30-day postoperative morbidity and overall survival in advanced-stage high-grade serous ovarian cancer patients after primary surgery.
A retrospective study was conducted on consecutive patients who underwent primary surgery for high-grade serous ovarian cancer between January 2008 and December 2016 at a single tertiary academic institution in Toronto, Canada. Optimal thresholds for preoperative neutrophil-to-lymphocyte ratio were determined using receiver-operator characteristic curve analysis. Cox-proportional hazard models, Kaplan-Meier, and logistic regression analyses were performed.
Of 505 patients with ovarian cancer during the study period, 199 met the inclusion criteria. Receiver-operator characteristic curve analysis generated optimal preoperative neutrophil-to-lymphocyte ratio thresholds of 2.3 and 2.9 for 30-day postoperative morbidity and survival outcomes, respectively. A neutrophil-to-lymphocyte ratio ≥2.3 was predictive of a composite outcome of 30-day postoperative complications (odds ratio 7.3, 95% confidence interval 2.44 to 21.81; p=0.0004), after adjusting for longer operative time and intraoperative complications. Postoperative complications included superficial surgical site infections (p=0.007) and urinary tract infections (p=0.004). A neutrophil-to-lymphocyte ratio ≥29 was associated with worse 5-year overall survival (57.8% vs 77.7%, p=0.003), and suggested no statistically significant difference in progression-free survival (33.8% vs 40.7%, p=0.054). On multivariable analysis, the neutrophil-to-lymphocyte ratio remained an independent predictor for overall survival (p=0.02) when adjusting for suboptimal cytoreduction (p≤0.0001).
A preoperative neutrophil-to-lymphocyte ratio ≥2.3 and ≥2.9 is associated with greater risk of 30-day postoperative morbidity and worse overall survival, respectively. This marker may be used in conjunction with other risk assessment strategies to preoperatively identify high-risk patients. Further prospective study is required to investigate its role in clinical decision-making.
术前中性粒细胞与淋巴细胞比值已被证实是多种恶性肿瘤患者接受肿瘤外科手术的围手术期并发症和生存结果的独立预后指标。本研究的目的是评估术前中性粒细胞与淋巴细胞比值在预测原发性手术后晚期高级别浆液性卵巢癌患者 30 天术后发病率和总生存率方面的作用。
对 2008 年 1 月至 2016 年 12 月在加拿大多伦多一家三级学术机构接受原发性高级别浆液性卵巢癌手术的连续患者进行了回顾性研究。使用接收器工作特征曲线分析确定术前中性粒细胞与淋巴细胞比值的最佳阈值。进行 Cox 比例风险模型、Kaplan-Meier 和逻辑回归分析。
在研究期间，505 例卵巢癌患者中有 199 例符合纳入标准。接收者工作特征曲线分析产生的 30 天术后发病率和生存结果的最佳术前中性粒细胞与淋巴细胞比值阈值分别为 2.3 和 2.9。中性粒细胞与淋巴细胞比值≥2.3 预测 30 天术后并发症的复合结局（优势比 7.3，95%置信区间 2.44 至 21.81；p=0.0004），调整手术时间延长和术中并发症后。术后并发症包括浅表手术部位感染（p=0.007）和尿路感染（p=0.004）。中性粒细胞与淋巴细胞比值≥29 与 5 年总生存率较差相关（57.8%比 77.7%，p=0.003），无统计学意义的无进展生存率差异（33.8%比 40.7%，p=0.054）。多变量分析表明，在调整次优减瘤术（p≤0.0001）后，中性粒细胞与淋巴细胞比值仍然是总生存率的独立预测因子（p=0.02）。
术前中性粒细胞与淋巴细胞比值≥2.3 和≥2.9 分别与 30 天术后发病率增加和总生存率降低相关。该标志物可与其他风险评估策略结合使用，以术前识别高危患者。需要进一步的前瞻性研究来探讨其在临床决策中的作用。
