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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(07): 397-403
DOI: 10.1055/s-0040-1712991
Original Article
Oncology
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Diagnostic Value of the Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Thrombocytosis in the Preoperative Investigation of Ovarian Masses

Valor diagnóstico das razões neutrófilo/linfócito, plaqueta/linfócito, e trombocitose na investigação pré-operatória de massas ovarianas
Adriana Yoshida 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
,
Luís Otavio Sarian 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
,
Marcos Marangoni  Junior
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
,
Isis Caroline Firmano 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
,
Sophie Françoise Derchain 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

11 September 2018

23 April 2020

Publication Date:
19 June 2020 (online)

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Abstract

Objective To evaluate the diagnostic accuracy of cancer antigen 125 (CA125) and complete blood count (CBC) parameters, such as the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and thrombocytosis in patients with ovarian masses.

Methods The present is a retrospective study conducted at a single tertiary hospital from January 2010 to November 2016. We included consecutive women referred due to suspicious adnexal masses. The CBC and CA125 were measured in the serum of 528 women with ovarian masses before surgery or biopsy. We evaluated the diagnostic performance of the NLR, PLR, platelets (PLTs), CA125, and the associations between them. We tested the clinical utility of the CBC parameters and CA125 in the discrimination of ovarian masses through decision curve analysis (DCA).

Results The best balance between sensitivity and specificity was obtained by the associations of CA125 or PLTs ≥ 350/nL, with 70.14% and 71.66%, CA125 or PLTs ≥ 400/nL, with 67.30% and 81.79%, CA125 or PLR, with 76.3% and 64.87%, and CA125 or NLR, with 71.09% and 73.89% respectively. In the DCA, no isolated CBC parameter presented a higher clinical utility than CA125 alone.

Conclusion We showed that no CBC parameter was superior to CA125 in the prediction of the malignancy of ovarian tumors in the preoperative scenario.

Resumo

Objetivo Avaliar a acurácia diagnóstica do antígeno de câncer 125 (cancer antigen 125, CA125, em inglês) e dos parâmetros do hemograma como as razões neutrófilo/linfócito (RNL), plaqueta/linfócito (RPL), e trombocitose em pacientes com massas ovarianas.

Métodos Este é um estudo retrospectivo realizado em um hospital terciário no período de janeiro de 2010 a novembro de 2016. Foram incluídas de forma consecutiva mulheres encaminhadas por massas anexiais suspeitas. Foram dosados hemogramas e CA125 no soro de 528 mulheres com massas ovarianas antes da cirurgia ou biópsia. Foram avaliados os desempenhos diagnósticos da RNL, da RPL, das plaquetas (PLQs) e do CA125, considerando-os isoladamente e associados entre si. Testamos a utilidade clínica dos parâmetros do hemograma e do CA125 na discriminação das massas ovarianas por análise de curva de decisão (ACD).

Resultados Os melhores equilíbrios entre sensibilidade e especificidade foram obtidos por meio das associações do CA125 ou PLQs ≥ 350/nL, com 70,14% e 71,66%, CA125 ou PLQs ≥ 400/nL, com 67,30% e 81,79%, CA125 ou RPL, com 76,3% e 64,87%, e CA125 ou RNL, com 71,09% e 73,89%, respectivamente.

Conclusão Na ACD, nenhum parâmetro do hemograma isolado se mostrou superior ao CA125 na predição de malignidade de tumores ovarianos no pré-operatório.

Keywords

adnexal masses - diagnosis - ovarian cancer - serum biomarkers - thrombocytosis

Palavras-chave

massas anexiais - diagnóstico - câncer de ovário - biomarcadores séricos - trombocitose

Contributors

All authors were involved in the design and interpretation of the analyses, contributed to the writing of the manuscript, and read and approved the final manuscript.


 

  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424 . Doi: 10.3322/caac.21492
    CrossrefPubMedGoogle Scholar
  • 2 Saed GM, Diamond MP, Fletcher NM. Updates of the role of oxidative stress in the pathogenesis of ovarian cancer. Gynecol Oncol 2017; 145 (03) 595-602 . Doi: 10.1016/j.ygyno.2017.02.033
    CrossrefPubMedGoogle Scholar
  • 3 Zhao Z, Zhao X, Lu J, Xue J, Liu P, Mao H. Prognostic roles of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in ovarian cancer: a meta-analysis of retrospective studies. Arch Gynecol Obstet 2018; 297 (04) 849-857 . Doi: 10.1007/s00404-018-4678-8
    CrossrefPubMedGoogle Scholar
  • 4 Ye Q, Cheng J, Ye M, Liu D, Zhang Y. Association of pretreatment thrombocytosis with prognosis in ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol 2019; 30 (01) e5 . Doi: 10.3802/jgo.2019.30.e5
    CrossrefPubMedGoogle Scholar
  • 5 Yildirim MA, Seckin KD, Togrul C, Baser E, Karsli MF, Gungor T, Gulerman HC. Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses. Asian Pac J Cancer Prev 2014; 15 (16) 6881-6885 . Doi: 10.7314/apjcp.2014.15.16.6881
    CrossrefPubMedGoogle Scholar
  • 6 Bakacak M, Serin S, Ercan Ö, Köstü B, Bostancı MS, Bakacak Z. , 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 (01) 21-25 . Doi: 10.5152/jtgga.2015.0152
    CrossrefPubMedGoogle Scholar
  • 7 Watrowski R, Heinze G, Jäger C, Forster J, Zeillinger R. Usefulness of the preoperative platelet count in the diagnosis of adnexal tumors. Tumour Biol 2016; 37 (09) 12079-12087 . Doi: 10.1007/s13277-016-5090-2
    CrossrefPubMedGoogle Scholar
  • 8 Eo WK, Kim KH, Park EJ, Kim HY, Kim HB, Koh SB, Namkung J. Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses. J Cancer 2018; 9 (07) 1165-1172 . Doi: 10.7150/jca.23606
    CrossrefPubMedGoogle Scholar
  • 9 Menczer J. Preoperative elevated platelet count and thrombocytosis in gynecologic malignancies. Arch Gynecol Obstet 2017; 295 (01) 9-15 . Doi: 10.1007/s00404-016-4212-9
    CrossrefPubMedGoogle Scholar
  • 10 Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J. , et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med 2012; 366 (07) 610-618 . Doi: 10.1056/NEJMoa1110352
    CrossrefPubMedGoogle Scholar
  • 11 Buergy D, Wenz F, Groden C, Brockmann MA. Tumor-platelet interaction in solid tumors. Int J Cancer 2012; 130 (12) 2747-2760 . Doi: 10.1002/ijc.27441
    CrossrefPubMedGoogle Scholar
  • 12 Ethier JL, Desautels DN, Templeton AJ, Oza A, Amir E, Lheureux S. Is the neutrophil-to-lymphocyte ratio prognostic of survival outcomes in gynecologic cancers? A systematic review and meta-analysis. Gynecol Oncol 2017; 145 (03) 584-594 . Doi: 10.1016/j.ygyno.2017.02.026
    CrossrefPubMedGoogle Scholar
  • 13 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 (01) 443 . Doi: 10.1186/s12885-018-4318-5
    CrossrefPubMedGoogle Scholar
  • 14 Flahault A, Cadilhac M, Thomas G. Sample size calculation should be performed for design accuracy in diagnostic test studies. J Clin Epidemiol 2005; 58 (08) 859-862 . Doi: 10.1016/j.jclinepi.2004.12.009
    CrossrefPubMedGoogle Scholar
  • 15 Kurman RJ, Carcangiu ML, Herrington CS, Young RH. WHO Classification of Tumours of Female Reproductive Organs. 4th ed. Lyon: IARC; 2014
    Google Scholar
  • 16 Prat J. ; FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124 (01) 1-5 . Doi: 10.1016/j.ijgo.2013.10.001
    CrossrefPubMedGoogle Scholar
  • 17 R Core Team [Internet]. The R project for statistical computing. Vienna: R Foundation; 2016 [cited 2018 Feb 12]. Available from: https://www.R-project.org/
    PubMed
  • 18 DecisionCurve: calculate and plot decision curves [Internet]. 2017 [cited 2018 Feb 12]. Available from: https://mran.microsoft.com/snapshot/2017-04-22/web/packages/DecisionCurve/index.html
    PubMed
  • 19 Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 2006; 26 (06) 565-574 . Doi: 10.1177/0272989X06295361
    CrossrefPubMedGoogle Scholar
  • 20 Coussens LM, Werb Z. Inflammation and cancer. Nature 2002; 420 (6917): 860-867 . Doi: 10.1038/nature01322
    CrossrefPubMedGoogle Scholar
  • 21 Kundu JK, Surh YJ. Emerging avenues linking inflammation and cancer. Free Radic Biol Med 2012; 52 (09) 2013-2037 . Doi: 10.1016/j.freeradbiomed.2012.02.035
    CrossrefPubMedGoogle Scholar
  • 22 Prodromidou A, Andreakos P, Kazakos C, Vlachos DE, Perrea D, Pergialiotis V. The diagnostic efficacy of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ovarian cancer. Inflamm Res 2017; 66 (06) 467-475 . Doi: 10.1007/s00011-017-1026-6
    CrossrefPubMedGoogle Scholar