Abstract
Aim: To evaluate the predictive value of preoperative ratio of neutrophils to lymphocytes (NLR) in distinguishing between benign and malignant masses, as inflammation plays a significant role in the development and emergence of cancer.
Material and Method: This retrospective study included 155 patients who underwent surgery due to an adnexal mass between December 2020 and December 2021 (55 were malignant, 100 were benign). Age, parity, tumor stage, chemotherapy, CA 125, CRP, neutrophils, lymphocytes, NLR, were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. The cut-off values of the variables were determined by calculating the areas under the receiver operating characteristic curve (ROC) for the purposes of differential diagnosis in the presence of malignancy, and by analyzing the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood-ratio (LR) (+) values. A P-value of <0.05 was established as the significance level.
Results: Malignant tumors showed higher values of neutrophils, CA 125, CRP, and NLR (p=0.018, p=0.0001, p=0.001, p=0.01, respectively), whereas benign group showed higher values of lymphocytes (p=0.011). At cut-off> 2.79 for NLR; sensitivity was found to be 59.36%, specificity 75.51%, positive predictive value (PPV) 58.44, negative predictive value 75.58, LR (+) value 2.3. At cut-off> 36.9 for CA-125; sensitivity was 80.00%, specificity was 78.63%, positive predictive value was 67.72%, negative predictive value was 87.53%, LR (+) value was 3.73.
Conclusion: The primary outcome of our study is that the likelihood of malignancy in a patient with an NLR value of>2.79 is 2.3 times higher than in a patient with an NLR value of <2.79 in distinguishing between benign and malignant adnexal masses. The secondary outcome is that the likelihood of malignancy in a patient with a CA-125 value of>36.9 is 3.73 times higher than in a patient with a CA-125 value of <36.9.
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References
- Siegel RL, Miller KD, Jemal A Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7–30.
- Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Prim 2016; 2: 1–22.
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- Eo WK, Kim KH, Park EJ, et al. Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses. J Cancer 2018; 9: 1165–72.
- Bakacak M, Serin S, Ercan Ö, 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: 21–5.
- Zappavigna S, Cossu AM, Grimaldi A, et al. Anti-inflammatory drugs as anticancer agents. Int J Mol Sci 2020; 21: 2605.
- Nie W, Yu T, Sang Y, Gao X. Tumor-promoting effect of IL-23 in mammary cancer mediated by infiltration of M2 macrophages and neutrophils in tumor microenvironment. Biochem Biophys Res Commun 2017; 482: 1400-06.
- Feng JF, Huang Y, Zhao Q, Chen QX. Clinical significance of preoperative neutrophil lymphocyte ratio versus platelet lymphocyte ratio in patients with small cell carcinoma of the esophagus. Scientific World Journal 2013: 504365.
- 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: 864–69.
- Suppan C, Bjelic-Radisic V, La Garde M, et al. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC cancer 2015; 15: 1027.
- Chen L, Wang X, Shu J, Xu S, Wu Q, Yu Y. Diagnostic value of serum D-dimer, CA125, and neutrophil-to-lymphocyte ratio in differentiating ovarian cancer and endometriosis. Int J Gynaecol Obstet 2019; 147: 212-18.
- Wang Q, Feng X, Liu X, Zhu S. Prognostic value of elevated pre-treatment serum CA-125 in epithelial ovarian cancer: A meta-analysis. Front Oncol 2022; 12: 868061.
- Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemotherapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark 2016; 17: 33-40.
- Chen S, Zhang L, Yan G, et al. Neutrophil-to-Lymphocyte Ratio Is a Potential Prognostic Biomarker in Patients with Ovarian Cancer: A Meta-Analysis. Biomed Res Int 2017; 2017: 7943467.
Abstract
Keywords
Project Number
-
References
- Siegel RL, Miller KD, Jemal A Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7–30.
- Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Prim 2016; 2: 1–22.
- Coussens LM, Werb Z. Inflammation and cancer. Nature 2002; 1926; 420: 860-7.
- Xue TC, Zhang L, Xie XY, et al. Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis. PLoS One 2014; 9: 0.
- Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88: 218–30.
- Eo WK, Kim KH, Park EJ, et al. Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses. J Cancer 2018; 9: 1165–72.
- Bakacak M, Serin S, Ercan Ö, 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: 21–5.
- Zappavigna S, Cossu AM, Grimaldi A, et al. Anti-inflammatory drugs as anticancer agents. Int J Mol Sci 2020; 21: 2605.
- Nie W, Yu T, Sang Y, Gao X. Tumor-promoting effect of IL-23 in mammary cancer mediated by infiltration of M2 macrophages and neutrophils in tumor microenvironment. Biochem Biophys Res Commun 2017; 482: 1400-06.
- Feng JF, Huang Y, Zhao Q, Chen QX. Clinical significance of preoperative neutrophil lymphocyte ratio versus platelet lymphocyte ratio in patients with small cell carcinoma of the esophagus. Scientific World Journal 2013: 504365.
- 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: 864–69.
- Suppan C, Bjelic-Radisic V, La Garde M, et al. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC cancer 2015; 15: 1027.
- Chen L, Wang X, Shu J, Xu S, Wu Q, Yu Y. Diagnostic value of serum D-dimer, CA125, and neutrophil-to-lymphocyte ratio in differentiating ovarian cancer and endometriosis. Int J Gynaecol Obstet 2019; 147: 212-18.
- Wang Q, Feng X, Liu X, Zhu S. Prognostic value of elevated pre-treatment serum CA-125 in epithelial ovarian cancer: A meta-analysis. Front Oncol 2022; 12: 868061.
- Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemotherapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomark 2016; 17: 33-40.
- Chen S, Zhang L, Yan G, et al. Neutrophil-to-Lymphocyte Ratio Is a Potential Prognostic Biomarker in Patients with Ovarian Cancer: A Meta-Analysis. Biomed Res Int 2017; 2017: 7943467.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Project Number | - |
| Publication Date | May 31, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 3 |
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