Lymphocyte-to-monocyte ratio after primary surgery is an independent prognostic factor for patients with epithelial ovarian cancer: A propensity score matching analysis

Qian Hu; Guihua Shen; Ye Li; Ya Xie; Xiao Ma; Lijuan Jiang; Qiubo Lv

doi:10.3389/fonc.2023.1139929

Lymphocyte-to-monocyte ratio after primary surgery is an independent prognostic factor for patients with epithelial ovarian cancer: A propensity score matching analysis

Front Oncol. 2023 Mar 22:13:1139929. doi: 10.3389/fonc.2023.1139929. eCollection 2023.

Authors

Qian Hu¹, Guihua Shen¹, Ye Li¹, Ya Xie², Xiao Ma³, Lijuan Jiang⁴, Qiubo Lv¹

Affiliations

¹ Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
² Gynecology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Obstetrics and Gynecology, Beijing Pinggu Hospital, Beijing, China.
⁴ Department of Obstetrics and Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China.

Abstract

Background: The aim of this study was to elucidate the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR) after primary surgery in epithelial ovarian cancer (EOC) patients using a propensity score matching (PSM) analysis.

Methods: We retrospectively reviewed consecutive EOC patients who underwent primary surgery between January 2008 and December 2019. Patients were divided into two groups according to the optimal cutoff value of preoperative LMR. PSM (1:1) was conducted to eliminate confounding factors. A Cox proportional hazards model and the Kaplan-Meier estimator were employed to investigate the potential prognostic factors.

Results: A total of 368 EOC patients were included in this study. The optimal cutoff value of LMR was identified as 4.65. Low preoperative LMR was significantly correlated with low albumin, high CA125 level, more blood loss, a high likelihood of ascites, advanced FIGO stage, and poor differentiation (all p < 0.05). After matching, Kaplan-Meier curves showed that the group with LMR < 4.65 experienced significantly shorter OS (p = 0.015). Multivariate Cox analysis revealed that low LMR (HR = 1.49, p = 0.041), advanced FIGO stage (HR = 5.25, p < 0.001), and undefined residual disease (HR = 3.77, p = 0.002) were independent factors in predicting poor OS. A forest plot revealed that LMR had better prognostic value in younger EOC patients, patients with BMI ≥ 25 kg/m² and albumin ≥ 35 g/L, CA125 ≥ 35 U/L, patients who had undergone optimal surgery, and those who had completed chemotherapy. Additionally, low-LMR patients who had undergone incomplete chemotherapy had a shorter median OS compared with those who completed chemotherapy treatment (48.5 vs. 105.9 months, p = 0.026).

Conclusions: LMR could be used as an independent prognostic factor for EOC patients after primary surgery; a noticeable negative effect of LMR was observed among EOC patients with age < 65, good preoperative nutritional status, and more aggressive tumor biology, and among those who underwent optimal surgery. Completing adjuvant chemotherapy is essential to improve survival outcomes among EOC patients with LMR < 4.65 after surgery.

Keywords: adjuvant chemotherapy; epithelial ovarian cancer; lymphocyte-to-monocyte ratio; overall survival; propensity score matching.