Publication:

Systemic inflammatory markers neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios as therapy response markers of epithelial ovarian cancer in Adam Malik Hospital Medan

Background Ovarian cancer has a complex pathological type, high recurrence rate, poor therapy response and prognosis. In recent years, examination of inflammatory markers of ovarian cancer therapy response has been developed. Systemic inflammatory response is closely related to cancer initiation, development and metastasis so that it can be used as a therapy response of ovarian cancer. This study aims to determine the systemic inflammatory markers NLR, PLR and MLR as a therapy response of epithelial ovarian cancer patients stage III after optimal debulking and complete adjuvant chemotherapy.

Methods This study is an observational analytical study with a diagnostic test design on systemic blood inflammatory markers NLR, PLR, and MLR as marker of therapy response of epithelial ovarian cancer patients at Adam Malik Hospital Medan using retrospective data. This study involved a total of 135 patients with stage III epithelial ovarian cancer patients who had undergone optimal debulking and complete adjuvant chemotherapy from January 1 2018 to December 31 2022 with complete follow-up for 1 year.

Results Based on the results of ROC curve analysis, the optimal cut off value for NLR was 2.4 (AUC: 73.2%, 95% CI: 64.1-82.4%, p<0.001) with a sensitivity of 69.9% and a specificity of 66.67%. The optimal cut off value for PLR was 173 (AUC: 82%, 95% CI: 74.4-89.5%, p<0.001) with a sensitivity of 77.4% and a specificity of 73.8%. The optimal cut off value for MLR was 0.5 (AUC: 66.2%, 95% CI: 54.9-77.6%, p<0.001) with a sensitivity of 71% and a specificity of 69%. There was a significant association between the NLR, PLR, and MLR values with the response to therapy in stage III epithelial ovarian cancer patients who had undergone debulking laparotomy and complete adjuvant chemotherapy (p<0.001). The result of multivariate analysis showed that the most dominant variable in predicting therapy response of epithelial ovarian cancer patients was PLR with the largest OR value of 7.823 (95% CI 7.268-187.947).

Conclusions The optimal cut-off values of NLR, PLR, MLR statistically significant with therapy response of stage III epithelial ovarian cancer who had undergone optimal debulking and complete adjuvant chemotherapy. Increased levels of NLR, PLR, and MLR were more likely to be associated with a non-complete therapy response.