Prognostic value of preoperative peripheral blood monocyte to lymphocyte ratio combined with fibrinogen in patients with epithelial ovarian cancer / 中国医师进修杂志

ABSTRACT

Objective:To investigate the prognostic value of peripheral blood monocyte to lymphocyte ratio (MLR) combined with fibrinogen (Fbg) in patients with epithelial ovarian cancer (EOC) before operation.Methods:Retrospectively included 80 patients with EOC who underwent surgical treatment at Gaochun Branch of Nanjing Drum Tower Hospital from January 2014 to January 2017. The boundary values of MLR and Fbg were determined by the receiver operating characteristic(ROC) curve, and then grouped by the critical value. The patients were evaluated with age, FIGO stage, lymphatic metastasis, and venous metastasis between groups. The 5-year cumulativesurvival rate was analyzed among the groups, and the independent risk factors influencing the prognosis of EOC were determined by Cox proportional risk regression model.Results:The predicted cut-off value of MLR was 0.25. Compared with the low MLR group (MLR<0.25, 38 cases), the high MLR group (MLR≥0.25, 42 cases) had a higher rate of lymphatic metastasis and venous metastasis 33.3%(14/42) vs. 13.2%(5/38), 33.3%(14/42) vs. 10.5%(4/38); and the proportion of patients in stage Ⅲ to Ⅳwas also higher66.7%(28/42) vs.18.4%(7/38), the differences were statistically significant ( P<0.05). The predicted cut-off value of Fbg concentration was 3.15 g/L. Compared with the low Fbg group (Fbg<3.15 g/L, 43 cases), the high Fbg group (Fbg≥3.15 g/L, 37 cases) had a higher rate of lymphatic metastasis and venous metastasis35.1%(13/37) vs. 14.0%(6/43), 32.4%(12/37) vs. 14.0%(6/43); and the proportion of patients in stage Ⅲ to Ⅳ was also higher 70.3%(26/37) vs. 20.9%(9/43), the differences were statistically significant ( P<0.05). At predicted cut-off value of MLR combined with Fbg, the patients were divided into the first group (Fbg<3.15 g/L, MLR<0.25, 27 cases), the second group (Fbg<3.15 g/L, MLR≥0.25 or Fbg≥3.15g/L, MLR<0.25, 31 cases) and the third group (Fbg≥3.15g/L,MLR≥0.25, 22 cases), there were statistically significant differences in the proportion of patients in stage Ⅲ to Ⅳ 7.4%(2/27), 48.4%(15/31), 81.8%(18/22); venous metastasis 7.4%(2/27), 19.4%(6/31), 45.5%(10/22); and lymphatic metastasis 3.7% (1/27), 25.8%(8/31), 45.5%(10/22) among the three groups ( P<0.01). The 5-year cumulative survival rate of EOC patients in the high MLR group was significantly lower than that in the low MLR group66.7% vs. 89.5%, P<0.05. The 5-year cumulative survival rate of patients in the high Fbg group was significantly lower than that in the low Fbg group64.9% vs. 88.4%, P<0.05. The 5-year survival rates of EOC patients in the first, second and third groups were 96.3%, 77.4% and 54.5%, respectively, with significant differences among the three groups ( P<0.01). Cox multivariate analysis showed that MLR, Fbg and MLR combined with Fbg were independent risk factors for survival of EOC patients ( P<0.05). Conclusions:Preoperative MLR combined with Fbg was closely related to the tumor progression and prognosis of EOC patients, and it could be used as an effective predictor of the prognosis of EOC patients.