The Diagnostic Accuracy of Hematologic Parameters, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio, in Malignant and Benign Epithelial Neoplasms of the Ovary in Philippine General Hospital Service Patients
DOI:
https://doi.org/10.21141/PJP.2021.12Keywords:
ovarian neoplasms, blood cell count, lymphocytes, neutrophils, blood plateletsAbstract
Background and Objectives. Early detection of ovarian neoplasms confer a better outcome and prognosis for patients. Although newer diagnostic modalities have been recently developed, the availability and accessibility of complete blood count parameters specifically, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) make it a convenient and cost-effective marker to aid as a pre-operative predictor of epithelial ovarian neoplasms. We aim to determine the significance and relationship of preoperative NLR and PLR in predicting a diagnosis of malignant surface epithelial ovarian tumor.
Methodology. We gathered surgical pathology reports and complete blood count parameters of service patients with benign and malignant surface epithelial ovarian neoplasms. Diagnostic accuracy of NLR and
PLR was determined by using receiver operating curve (ROC) plots. Optimal cutoff points were set using
the Youden index.
Results. We have included 351 cases of ovarian surface epithelial neoplasms, 209 of which were benign and 142 of which were malignant. The ROC curve for PLR had an area under curve (AUC) of 0.6629 [0.6043, 0.7215]. The optimal cut-off point of was set at 195.99 with the maximal Youden index of 0.295 [9.193, 0.396]. The corresponding sensitivity of this test to determine malignancy at this point was 56.5% [47.8, 64.6] while the specificity was at 73.2% [66.7, 79.1]. The ROC curve for NLR had an AUC of 0.6616 [0.6051, 0.7180]. The optimal cut-off point of was set at 2.60 with the maximal Youden index of 0.316 [0.219, 0.413]. The corresponding sensitivity of this test to determine malignancy at this point was 76.1% [68.2, 82.8] while the specificity was at 55.5% [48.5, 62.4].
Conclusion. The utility of CBC parameters such as PLR and NLR are cost-effective tools which may have some diagnostic value but, they cannot be used as a stand-alone predictor of malignancy and must be correlated with other clinical, laboratory and radiologic studies.
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References
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17. Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58(1):15-23. https://pubmed.ncbi.nlm.nih.gov/18414853. https://doi.org/10.1007/s00262-008-0516-3.
18. Prodromidou A, Andreakos P, Kazakos C, Vlachos DE, Perrea D, Pergialiotis V. The diagnostic efficacy of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ovarian cancer. Inflamm Res. 2017;66(6):467-75. https://pubmed.ncbi.nlm.nih.gov/28260123. https://doi.org/10.1007/s00011-017-1026-6.
19. Badora-Rybicka A, Nowara E, Starzyczny-Słota D. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio before chemotherapy as potential prognostic factors in patients with newly diagnosed epithelial ovarian cancer. ESMO Open. 2016;1(2):e000039. https://pubmed.ncbi.nlm.nih.gov/27843595. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070273. https://doi.org/10.1136/esmoopen-2016-000039.
20. Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemo- therapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark. 2016;17(1):33–40. https://pubmed.ncbi.nlm.nih.gov/27314290. https://doi.org/10.3233/CBM-160614.
21. Ozaksit G, Tokmak A, Kalkan H, Yesilyurt H. Value of the platelet to lymphocyte ratio in the diagnosis of ovarian neoplasms in adolescents. Asian Pac J Cancer Prev. 2015;16(5):2037-41. https://pubmed.ncbi.nlm.nih.gov/25773807. https://doi.org/10.7314/apjcp.2015.16.5.2037.
22. Polat M, Senol T, Ozkaya E, et al. Neutrophil to lymphocyte and platelet to lym- phocyte ratios increase in ovarian tumors in the presence of frank stromal invasion. Clin Transl Oncol. 2016;18(5):457–63. https://pubmed.ncbi.nlm.nih.gov/26289552. https://doi.org/10.1007/s12094-015-1387-7.
23. Yildirim MA, Seckin KD, Togrul C, et al. Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses. Asian Pac J Cancer Prev. 2014;15(16):6881–5. https://pubmed.ncbi.nlm.nih.gov/25169540. https://doi.org/10.7314/apjcp.2014.15.16.6881.
24. Bakacak M, Serin S, Ercan O, et al. Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses. J Turk Ger Gynecol Assoc. 2016;17(1):21–5. https://pubmed.ncbi.nlm.nih.gov/27026775. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794288. https://doi.org/10.5152/jtgga.2015.0152.
25. Seckin KD, Karsli MF, Yucel B, et al. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol. 2016;196:60–3. https://pubmed.ncbi.nlm.nih.gov/26683535. https://doi.org/10.1016/j.ejogrb.2015.10.025.
26. Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemo- therapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark. 2016;17(1):33–40. https://pubmed.ncbi.nlm.nih.gov/27314290. https://doi.org/10.3233/CBM-160614.
27. Arun-Muthuvel V, Jaya V. Pre-operative evaluation of ovarian tumors by risk of malignancy index, CA125 and ultrasound. Asian Pac J Cancer Prev. 2014;15(6):2929-32. https://pubmed.ncbi.nlm.nih.gov/24761927. https://doi.org/10.7314/apjcp.2014.15.6.2929.
2. Pauler DK, Menon U, Mcintosh M, et al. Factors influencing serum CA125II levels in healthy postmenopausal women. Cancer Epidemiol Biomarkers Prev. 2001;10(5):489-93. https://pubmed.ncbi.nlm.nih.gov/11352859.
3. Dong X, Men X, Zhang W, Lei P. Advances in tumor markers of ovarian cancer for early diagnosis. Indian J Cancer. 2014;51(Suppl 3):e72. https://pubmed.ncbi.nlm.nih.gov/25818738. https://doi.org/10.4103/0019-509X.154049.
4. Malati T, Kumari GR, Yadagiri B. Application of tumor markers in ovarian malignancies. Indian J Clin Biochem. 2001;16(2):224-33. https://pubmed.ncbi.nlm.nih.gov/23105325. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3453631. https://doi.org/10.1007/BF02864868.
5. Nomelini RS, Carrijo Chiovato AF, Abdulmassih FB, da Silva RC, Tavares-Murta BM, Murta EF. Neutrophil-to-lymphocyte ratio and platelet count as prognostic factors in ovarian malignancies. J Can Res Ther. 2019;15(6):1226-30. https://pubmed.ncbi.nlm.nih.gov/31898652. https://doi.org/10.4103/jcrt.JCRT_304_17.
6. Chon S, Lee S, Jeong D, Lim S, Lee K, Shin J. Elevated platelet lymphocyte ratio is a poor prognostic factor in advanced epithelial ovarian cancer. J Gynecol Obstet Hum Reprod. 2021;50(6):101849. https://pubmed.ncbi.nlm.nih.gov/32619726. https://doi.org/10.1016/j.jogoh.2020.101849.
7. Yoshida A, Sarian LO, Junior MM, Firmano IC, Derchain SF. Diagnostic value of the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and thrombocytosis in the preoperative investigation of ovarian masses. Rev Bras Ginecol Obstet. 2020;42(7):397-403. https://pubmed.ncbi.nlm.nih.gov/32559800. https://doi.org/10.1055/s-0040-1712991.
8. Grivennikov SI, Karin M. Inflammation and oncogenesis: a vicious connection. Curr Opin Genet Dev. 2010;20(1):65-71. https://pubmed.ncbi.nlm.nih.gov/20036794. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821983. https://doi.org/10.1016/j.gde.2009.11.004.
9. Templeton AJ, Ace O, Mcnamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204-12. https://pubmed.ncbi.nlm.nih.gov/24793958. https://doi.org/10.1158/1055-9965.EPI-14-0146.
10. Hanahan D, Weinberg RA. The hallmarks of cancer: perspectives for cancer. In: Oxford Textbook of Oncology, 3rd ed. Oxford University Press; 2016. https://doi.org/10.1093/med/9780199656103.003.0001.
11. Cedrés S, Torrejon D, Martínez A, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol. 2012;14(11):864–9. https://pubmed.ncbi.nlm.nih.gov/22855161. https://doi.org/10.1007/s12094-012-0872-5.
12. Sharma D, Singh G. Thrombocytosis in gynecological cancers. J Cancer Res Ther. 2017;13(2):193-7. https://pubmed.ncbi.nlm.nih.gov/28643732. https://doi.org/10.4103/0973-1482.189234.
13. Stone RL, Nick AM, Afshar-Kharghan V, et al. Abstract 3436: Mechanisms of paraneoplastic thrombocytosis in ovarian carcinoma. Cancer Research. 2010;70(Suppl 8):3436. https://doi.org/10.1158/1538-7445.AM10-3436.
14. Absenger G, Szkandera J, Stotz M, et al. Preoperative neutrophil-to-lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer. Anticancer Res. 2013;33(10):4591-4. https://pubmed.ncbi.nlm.nih.gov/24123035.
15. Ceran MU, Tasdemir U, Colak E, et al. Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis? - a survival analysis. J Ovarian Res. 2019;12(1):16. https://pubmed.ncbi.nlm.nih.gov/30744662. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371536. https://doi.org/10.1186/s13048-019-0491-7.
16. Komura N, Mabuchi S, Yokoi E, et al. Comparison of clinical utility between neutrophil count and neutrophil-lymphocyte ratio in patients with ovarian cancer: a single institutional experience and a literature review. Int J Clin Oncol. 2018;23(1):104-13. https://pubmed.ncbi.nlm.nih.gov/28951992. https://doi.org/10.1007/s10147-017-1180-4.
17. Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58(1):15-23. https://pubmed.ncbi.nlm.nih.gov/18414853. https://doi.org/10.1007/s00262-008-0516-3.
18. Prodromidou A, Andreakos P, Kazakos C, Vlachos DE, Perrea D, Pergialiotis V. The diagnostic efficacy of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ovarian cancer. Inflamm Res. 2017;66(6):467-75. https://pubmed.ncbi.nlm.nih.gov/28260123. https://doi.org/10.1007/s00011-017-1026-6.
19. Badora-Rybicka A, Nowara E, Starzyczny-Słota D. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio before chemotherapy as potential prognostic factors in patients with newly diagnosed epithelial ovarian cancer. ESMO Open. 2016;1(2):e000039. https://pubmed.ncbi.nlm.nih.gov/27843595. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070273. https://doi.org/10.1136/esmoopen-2016-000039.
20. Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemo- therapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark. 2016;17(1):33–40. https://pubmed.ncbi.nlm.nih.gov/27314290. https://doi.org/10.3233/CBM-160614.
21. Ozaksit G, Tokmak A, Kalkan H, Yesilyurt H. Value of the platelet to lymphocyte ratio in the diagnosis of ovarian neoplasms in adolescents. Asian Pac J Cancer Prev. 2015;16(5):2037-41. https://pubmed.ncbi.nlm.nih.gov/25773807. https://doi.org/10.7314/apjcp.2015.16.5.2037.
22. Polat M, Senol T, Ozkaya E, et al. Neutrophil to lymphocyte and platelet to lym- phocyte ratios increase in ovarian tumors in the presence of frank stromal invasion. Clin Transl Oncol. 2016;18(5):457–63. https://pubmed.ncbi.nlm.nih.gov/26289552. https://doi.org/10.1007/s12094-015-1387-7.
23. Yildirim MA, Seckin KD, Togrul C, et al. Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses. Asian Pac J Cancer Prev. 2014;15(16):6881–5. https://pubmed.ncbi.nlm.nih.gov/25169540. https://doi.org/10.7314/apjcp.2014.15.16.6881.
24. Bakacak M, Serin S, Ercan O, et al. Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses. J Turk Ger Gynecol Assoc. 2016;17(1):21–5. https://pubmed.ncbi.nlm.nih.gov/27026775. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794288. https://doi.org/10.5152/jtgga.2015.0152.
25. Seckin KD, Karsli MF, Yucel B, et al. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol. 2016;196:60–3. https://pubmed.ncbi.nlm.nih.gov/26683535. https://doi.org/10.1016/j.ejogrb.2015.10.025.
26. Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemo- therapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark. 2016;17(1):33–40. https://pubmed.ncbi.nlm.nih.gov/27314290. https://doi.org/10.3233/CBM-160614.
27. Arun-Muthuvel V, Jaya V. Pre-operative evaluation of ovarian tumors by risk of malignancy index, CA125 and ultrasound. Asian Pac J Cancer Prev. 2014;15(6):2929-32. https://pubmed.ncbi.nlm.nih.gov/24761927. https://doi.org/10.7314/apjcp.2014.15.6.2929.
Published
08/27/2021
How to Cite
Villaruel, A., & Damian, K. (2021). The Diagnostic Accuracy of Hematologic Parameters, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio, in Malignant and Benign Epithelial Neoplasms of the Ovary in Philippine General Hospital Service Patients. PJP, 6(2), 22–29. https://doi.org/10.21141/PJP.2021.12
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