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Journals / Journal of Basic and Clinical Health Sciences / 2026 / Volume: 10 Issue: 2

Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer

Orkun İlgen(Balıkesir Atatürk Şehir Hastanesi)0000-0002-0296-8504
Simge Tezel Yozgat(Balıkesir Atatürk Şehir Hastanesi)0000-0001-7763-5643
Gokhan Aras(Erzurum Şehir Hastanesi)0009-0004-9300-3610
Sibel Ejder Tekgündüz(Erzurum Şehir Hastanesi)0000-0002-0992-1944
Nazım Ozan Çelebioğlu(Erzurum City Hospital, Department of Obstetrics and Gynecology)0009-0007-1011-7332
Berrin Göktuğ Kadıoğlu(Erzurum Şehir Hastanesi)0000-0002-8712-318X
Pages
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Publication Date
2026-05-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.

📌 3 Key Takeaways

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Objective & Hypothesis:Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory.
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Key Findings & Data:This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer.
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Conclusion & Impact:The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.
🔬Design:Research Article
📍Scope:2021 Verileri
⚙️Variables:ovarian cancer · serous carcinoma · monocyte-lymphocyte ratio

Abstract

Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory. This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer. Material and methods: NLR, PLR, and MLR were calculated from preoperative blood samples of 63 treatment-naive ovarian cancer patients (58 serous, 92.1%) who underwent primary debulking surgery. FIGO 2021 staging criteria were used. Mann-Whitney U and Kruskal-Wallis tests (with Bonferroni correction) were used for intergroup comparisons; multivariate logistic regression analysis was applied to determine independent predictors. The discriminative performance of MLR was evaluated using ROC analysis. Results: 92.1% of the cohort had serous histology, and 61.9% had advanced-stage disease (FIGO stages III-IV). In multivariate analysis (adjusted for age and menopause), only MLR was found to be independently associated with advanced-stage disease (adjusted OR: 4.25; 95% CI: 1.24-14.49; p=0.021). NLR and PLR showed no significance. MLR was also associated with peritoneal metastasis (p=0.017) and intestinal infiltration (p=0.019). In ROC analysis, the AUC was 0.706 (95% CI: 0.567-0.845; p=0.006). The optimal cut-off value was determined as 0.30 (sensitivity 48.7%, specificity 91.7%); an alternative cut-off value of 0.17 (sensitivity 82.1%, specificity 50.0%) was evaluated for high sensitivity. Conclusion: In treatment-naive serous ovarian cancer, MLR demonstrated superior performance compared to NLR and PLR in predicting advanced disease and peritoneal metastasis (adjusted OR: 4.25; AUC: 0.706). This finding supports the clinical significance of the monocyte-macrophage axis in serous ovarian cancer with predominantly transcoelomic spread. The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.

Özet

Amaç: Over kanserinde sistemik inflamatuvar belirteçlerin prognostik değeri çelişkilidir. Bu çalışma, tedavi-naif seröz over kanserinde monosit-lenfosit oranının (MLR) ileri evre hastalık ve peritoneal metastazı öngörme performansını nötrofil-lenfosit (NLR) ve trombosit-lenfosit oranı (PLR) ile karşılaştırmayı amaçlamıştır. Yöntem: Primer debulking cerrahi uygulanan 63 tedavi-naif over kanseri hastasının (58 seröz, %92.1) preoperatif kan örneklerinden NLR, PLR ve MLR hesaplandı. FIGO 2021 evreleme kriterleri kullanıldı. Gruplar arası karşılaştırmada Mann-Whitney U ve Kruskal-Wallis testleri (Bonferroni düzeltmeli) kullanıldı; bağımsız prediktörlerin belirlenmesinde çok değişkenli lojistik regresyon analizi uygulandı. MLR'nin diskriminatif performansı ROC analizi ile değerlendirildi. Bulgular: Kohortun %92.1'i seröz histolojiye, %61.9'u ileri evre (FIGO evre III-IV) hastalığa sahipti. Çok değişkenli analizde (yaş ve menopoz için düzeltilmiş), sadece MLR ileri evre hastalıkla bağımsız ilişkili bulundu (düzeltilmiş OR: 4.25; %95 GA: 1.24-14.49; p=0.021). NLR ve PLR anlamlılık göstermedi. MLR peritoneal metastaz (p=0.017) ve intestinal infiltrasyon (p=0.019) ile de ilişkiliydi. ROC analizinde AUC 0.706 (%95 GA: 0.567-0.845; p=0.006) bulundu. Optimal cut-off değeri 0.30 (sensitivite %48.7, spesifisite %91.7) olarak belirlendi; yüksek sensitivite için alternatif cut-off değeri 0.17 (sensitivite %82.1, spesifisite %50.0) değerlendirildi. Sonuç: Tedavi-naif seröz over kanserinde MLR, ileri evre hastalık ve peritoneal metastazı öngörmede NLR ve PLR'ye kıyasla üstün performans göstermiştir (düzeltilmiş OR: 4.25; AUC: 0.706). Bu bulgu, transkoelomik yayılımın baskın olduğu seröz over kanserinde monosit-makrofaj aksının klinik önemini desteklemektedir. MLR'nin prognostik değeri ve optimal cut-off değerleri prospektif çok merkezli çalışmalarla doğrulanmalıdır.

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Cite This Article

İlgen, O., Yozgat, S. T., Aras, G., Tekgündüz, S. E., Çelebioğlu, N. O., Kadıoğlu, B. G. (2026). Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer. Journal of Basic and Clinical Health Sciences, Volume: 10 Issue: 2. https://doi.org/10.30621/jbachs.1918061

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References (23)

  1. Ren Y, Xu R, Wang Y, Su L, Su J. Global, regional, and national burden of ovarian cancer in women aged 45 + from 1990 to 2021 and projections for 2050: a systematic analysis based on the 2021 global burden of disease study. J Cancer Res Clin Oncol. 2025 Aug 2;151(8):225.
  2. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. Ca. 2025;75(1):10–45.
  3. Greten FR, Grivennikov SI. Inflammation and Cancer: Triggers, Mechanisms and Consequences. Immunity. 2019;51(1):27–41.
  4. Hinshaw DC, Shevde LA. The Tumor Microenvironment Innately Modulates Cancer Progression. Cancer Res. 2019;79(18):4557–66.
  5. Schweer D, McAtee A, Neupane K, Richards C, Ueland F, Kolesar J. Tumor-Associated Macrophages and Ovarian Cancer: Implications for Therapy. Cancers. 2022;14(9):2220.
  6. Savant SS, Sriramkumar S, O’Hagan HM. The Role of Inflammation and Inflammatory Mediators in the Development, Progression, Metastasis, and Chemoresistance of Epithelial Ovarian Cancer. Cancers. 2018;10(8):251.
  7. Cupp MA, Cariolou M, Tzoulaki I, Aune D, Evangelou E, Berlanga-Taylor AJ. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020;18:360.
  8. Balescu I, Eftimie M, Petrea S, et al. Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer. Cancers. 2024;16(2):254.
  9. Bizon M, Olszewski M, Krason B, et al. The Diagnostic Role of the Platelet-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2025;26(5).
  10. Zhao Z, Xu H, Ma B, Dong C. Prognostic value of platelet to lymphocyte ratio (PLR) in breast cancer patients receiving neoadjuvant therapy: a systematic review and meta-analysis. Front Immunol. 2025 Aug 20;16.
  11. Ding N, Pang Z, Shen H, Ni Y, Du J, Liu Q. The Prognostic Value of PLR in Lung Cancer, a Meta-analysis Based on Results from a Large Consecutive Cohort. Sci Rep. 2016 5;6(1):34823.
  12. Sanna E, Tanca L, Cherchi C, et al. Decrease in Neutrophil-to-Lymphocyte Ratio during Neoadjuvant Chemotherapy as a Predictive and Prognostic Marker in Advanced Ovarian Cancer. Diagnostics. 2021;11(7):1298.
  13. Plaja A, Teruel I, Ochoa-de-Olza M, et al. Prognostic Role of Neutrophil, Monocyte and Platelet to Lymphocyte Ratios in Advanced Ovarian Cancer According to the Time of Debulking Surgery. Int J Mol Sci. 2023;24(14):11420.
  14. Miyamoto T, Murphy B, Zhang N. Intraperitoneal metastasis of ovarian cancer: new insights on resident macrophages in the peritoneal cavity. Front Immunol. 2023;14:1104694.
  15. Lisio MA, Fu L, Goyeneche A, Gao ZH, Telleria C. High-Grade Serous Ovarian Cancer: Basic Sciences, Clinical and Therapeutic Standpoints. Int J Mol Sci. 2019;20(4):952.
  16. Cucurull M, Felip E, Garcia JJ, et al. Prognostic value of monocyte to lymphocyte ratio (MLR) in epithelial ovarian cancer (EOC). J Clin Oncol. 2019;37(15_suppl):e17066–e17066.
  17. Cao Y, Ni X, Wang Y, et al. Clinical and prognostic significance of combined plasma fibrinogen concentrations and the monocyte-to-lymphocyte ratio in patients with ovarian cancer. Ann Transl Med. 2019;7(11):242–242.
  18. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Hematopoietic Growth Factors. National Comprehensive Cancer Network; 2023 June. Report No.: Version 2.2023.
  19. Kim YJ, Lee I, Chung YS, et al. Pretreatment neutrophil-to-lymphocyte ratio and its dynamic change during neoadjuvant chemotherapy as poor prognostic factors in advanced ovarian cancer. Obstet Gynecol Sci. 2018;61(2):227–34.
  20. Zhu Y, Zhou S, Liu Y, Zhai L, Sun X. Prognostic value of systemic inflammatory markers in ovarian Cancer: a PRISMA-compliant meta-analysis and systematic review. BMC Cancer. 2018;18(1):443.
  21. Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynecol Obstet. 2021;155(S1):61–85.
  22. Espinós J, Aramendía JM, González-Martín A, et al. Prognostic value of systemic inflammation response indexes obtained from the complete blood count in patients treated for advanced ovarian carcinoma in front line. Clin Transl Oncol. 2024;26(12):3211–7.
  23. Bektaş O, Bektaş K. Prognostic value of systemic inflammatory markers in predicting neoadjuvant platinum response and platinum resistance in advanced epithelial ovarian cancer: A peritoneal cancer index-based analysis. Gynecol Oncol. 2025;199:147–51.