Evaluation of inflammatory mediators as predictors ofprogression-free time (PFS) in patients with ovarian cancer(HGSOC) before and during treatment
Authors: Rychlik Urszula , Szatkowski Wiktor , Kałamacki Andrzej , Janicka Aneta , Górniak Karolina , Górniak Karolina , Blecharz Paweł 
Published: February 2025

Introduction: Chronic inflammation has been shown to be associated with cancerdevelopment. In recent years, laboratory markers of the systemic inflammatoryresponse have been studied mainly NLR, less frequently LMR and PLR.Most often, their usefulness has been assessed before treatment and lessoften at other treatment points; nevertheless, their role remains controversial.Aim: The aim of this study was to evaluate the predictive value of selected inflammatory markers in relation to time to disease progression (PFS).Material and methods: Sixty-four patients with high-grade serous ovarian cancer (HGSOC) who underwentcombined sequential treatment: primary surgery (PDS) or distant surgery (IDS) together with chemotherapywere enrolled in the study. NLR, LMR, PLR and PNR tests were performed before the combined treatment andafter cytoreductive surgery and the 3rd cycle of first-line chemotherapy. ROC characteristic curve analysiswas used to determine the optimal cut-off values of the variables to predict progression-free survival (PFS)(progression to 12 months and beyond 12 months).Results: Patients with ovarian cancer after 3 cycles of chemotherapy and surgical treatment (PDS or IDS) hadsignificantly lower values of assessed laboratory parameters compared to the results before combinationtreatment. In the group of patients with R0 radical cytoreduction and others with R1 + R2, only the medians ofbaseline LMR and PLR differed significantly, 3.82 vs. 2.85 and 213.3 vs. 265.9, respectively. Patients in whomprogression occurred 12 months after treatment had significantly lower baseline NLR (3.05 vs. 4.59) andsignificantly higher LMR (3.30 vs. 2.55) compared to those with PFS ≤12 months. After 3 cycles of chemotherapyin combination treatment, only the PLR-3 value was significantly lower in the group of patients withPFS >12 months compared to the other patients (155.5 vs. 188.56). There was also a trend towards lowerPNR values in the group with PFS >12 months (74.5 vs. 88.6). The areas under the AUC curves for NLR andLMR before the combination treatment did not differ significantly, while significant differences were shownbetween the areas of: NLR vs. PLR-3 (p = 0.0036) and LMR vs. PLR-3 (p = 0.0035). In the group of patientswith disease progression within 12 months of treatment, NLR values >4.02; LMR <2.81 or PLR-3 >158.4 had,respectively: 62%, 65% and 77%, compared to: 22%, 22% and 47% of patients. Kaplan-Meier curve analysis ofsurvival time to disease progression showed significant differences for NLR, LMR before combination treatmentand PLR-3 values after the 3rd cycle of chemotherapy at the study point.Conclusions:• This study showed that haematological indices of inflammation, such as neutrophil-to-lymphocyte ratio(NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR), have significant prognosticsignificance in patients with advanced ovarian cancer. Higher NLR and PLR values and lower LMRvalues before combination treatment were associated with shorter freedom from disease progression.• PLR after three chemotherapy cycles (PLR-3) of combination treatment was higher in patients with shorterPFS and was associated with shorter progression-free survival (12 months vs. 16 months).• The results also indicate an association between LMR and PLR levels and the extent of cytoreductionperformed. Higher LMR and lower PLR occurred in patients who achieved complete tumour resection (R0).