The diagnostic value of systemic inflammatory response markers as predictors of epithelial ovarian cancer


  • Justina O. Alegbeleye Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
  • Terhemen Kasso Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria



Ovarian malignancy, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Predictive value, Systemic inflammatory response markers


Background: Early detection of ovarian neoplasms confers a better outcome and prognosis for patients. Although newer diagnostic modalities have been recently developed, the availability and accessibility of complete blood count parameters make it a convenient and cost-effective marker for malignancy. Objectives were to evaluate the diagnostic accuracy of pretreatment neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with late-stage epithelial ovarian malignancy at the University of Port Harcourt Teaching Hospital.

Methods: A prospective analysis of fifty-seven women with histologic diagnosis of epithelial ovarian cancer who were managed at the University of Port Harcourt Teaching Hospital between January 1, 2018, and December 31, 2022, was conducted. A data collection form was used to obtain socio-demographic and clinico-pathological characteristics from the patients after informed consent was obtained. Pretreatment levels of NLR and PLR were determined from complete blood count. The Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive accuracy of the haematological parameters for late-stage epithelial ovarian cancer.

Results: Higher values of NLR and PLR were significantly associated with the stage of ovarian cancer (p=0.001). The optimal cut-off points based on ROC curve analyses for NLR and PLR were found to be 2.6 (AUC=0.61, p>0.05), and 155.8 (AUC=0.62, p>0.05) respectively. However, none of the haematological parameters could be used as predictive markers for advanced-stage ovarian cancer in this study.

Conclusions: Pretreatment NLR and PLR cannot be used as a stand-alone predictor of advanced ovarian cancer, and should be correlated with other clinical, laboratory and radiologic parameters.


Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 cancers in 185 countries. Ca Cancer J Clin. 2021;71(3):209-49.

Bowtell DD, Bohm S, Ahmed AA, Aspuria PJ, Bast RC, Beral V, et al. Rethinking ovarian cancer II: reducing mortality from high-grade serous ovarian cancer. Nat Rev Cancer. 2015;15(11):668-79.

Siegel RL, Miller KD, Jemal A. Cancer statistics. CA: a cancer journal for clinicians. 2015;65(1):5-29.

Okunade KS, Okunola H, Okunowo AA. A five-year review of ovarian cancer at a tertiary institution in Lagos, South-west, Nigeria Nigeria J Gen Pract. 2016;14:23-7.

Zayyan MS, Ahmed SA, Oguntayo AO, Kolawole AO, Olasinde TA. Epidemiology of ovarian cancers in Zaria, Northern Nigeria: a 10-year study. Int J Women’s Health. 2017;9:855-60.

Iyoke CA, Ugwu GO. Burden of gynaecological cancers in developing countries. World Obstet Gynaecol. 2013;2(1):1-7.

Ugwu EO, Iferikigwe ES, Okeke TC, Ugwu AO, Okezie OA, Agu PU. Pattern of gynaecological cancers in University of Nigeria Teaching Hospital, Enugu, Southeastern Nigeria. Niger J Med. 2011;20(2):266-9.

Wentzensen N, Poole EM, Trabert B, White E, Arslan AA, Patel AV, et al. Ovarian cancer risk factors by histologic subtypes: An analysis from the ovarian cancer cohort consortium. J Clin Oncol. 2016;34(24):2888-98.

Surveillance, Epidemiology and End Results (SEER) Programme. Bethesda MD: National Cancer Institute, National Institutes of Health. USA. 2016.

Bast RC, Skates S, Lokshin A, Moore RG. Differential diagnosis of a pelvic mass: improved algorithms and novel biomarkers. Int J Gynecol Cancer. 2012;22:S5-8.

Peek RM Jr., Mohla S, DuBois RN. Inflammation in the genesis and perpetuation of cancer: summary and recommendations from a national cancer institute-sponsored meeting. Cancer Res. 2005;65:8583-6.

Costantini S, Capone F, Guerriero E, Castello G. An approach for understanding the inflammation and cancer relationship. Immunol Lett. 2009;126:91-2.

Hainaut P, Plymoth A. Targeting the hallmarks of cancer. Curr Opin Oncol. 2013;25:50-1.

Hanahan D, Weinberg R. Hallmarks of cancer: the next generation. Cell. 2011;144:646-74.

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.

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.

Grivennikov SI, Karin M. Inflammation and oncogenesis: a vicious connection. Curr Opin Genet Dev. 2010;20(1):65-71.

Templeton AJ, Ace O, Mcnamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, 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.

Hanahan D, Weinberg RA. The hallmarks of cancer: perspectives for cancer. In: Oxford Textbook of Oncology, 3rd ed. Oxford University Press. 2016.

Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, 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.

Sharma D, Singh G. Thrombocytosis in gynecological cancers. J Cancer Res Ther. 2017;13(2):193-7.

Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J, et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med. 2012;366:610-8.

Absenger G, Szkandera J, Stotz M, Postlmayr U, Pichler M, Ress AL, 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.

Ceran MU, Tasdemir U, Colak E, Güngör, T. Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis? - a survival analysis. J Ovarian Res. 2019;12(1):16.

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.

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.

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.

Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, 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.

Balkwill F, Mantovani A. Inflammation, and cancer: back to Virchow? Lancet. 2001;357(9255):539-45.

Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-99.

Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44.

Jankova L, Dent OF, Chan C, Chapuis P, Clarke SJ. Preoperative neutrophil/ lymphocyte ratio predicts overall survival but does not predict recurrence or cancer-specific survival after curative resection of node-positive colorectal cancer. BMC Cancer. 2013;13:442.

Wei Y, Jiang YZ, Qian WH. Prognostic role of NLR in urinary cancers: a meta-analysis. PLoS One. 2014;9:e92079.

Yildirim MA, Seckin KD, Togrul C, Baser E, Karsli MF, Gungor T, 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.

Topcu HO, Guzel AI, Ozer I, Kokanali MK, Gokturk U, Muftuoglu KH, et al. Comparison of neutrophil/ lymphocyte and platelet/lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynaecology practice. Asian Pac J Cancer Prev. 2014;15(15):6239-41.

Dong J, Xue H, An F, Liu Y, Deng W, Gao Q. Correlation between the neutrophil-to-lymphocyte ratio and clinicopathological parameters in epithelial ovarian cancer patients and its effect on prognosis - a retrospective cohort study. Gland Surg. 2022;11(8):1367-73.

Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, et al. Prognostic significance, and Predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecol Oncol. 2014;132(3):542-50.

Feng Z, Wen H, Bi R, Ju X, Chen X, Yang W, et al. Preoperative Neutrophil-to-lymphocyte ratio as a Predictive and Prognostic factor for high-grade serous ovarian cancer. PLoS One. 2016;11(5):e0156101.

Yun TH, Jeong YY, Lee SJ, Choi YS, Ryu JM. Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Preoperative Differential Diagnosis of Benign, Borderline, and Malignant Ovarian Tumors. J Clin Med. 2022;11(5):1355.






Original Research Articles