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

Yoshida, Adriana; Sarian, Luís Otavio; Marangoni Junior, Marcos; Firmano, Isis Caroline; Derchain, Sophie Françoise

doi:10.1055/s-0040-1712991

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article, Oncology • Rev. Bras. Ginecol. Obstet. 42 (07) • July 2020 • https://doi.org/10.1055/s-0040-1712991 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
adnexal masses; diagnosis; ovarian cancer; serum biomarkers; thrombocytosis

	Benign^‡ ‡ Benign disease involves benign ovarian tumors and ovarian non-neoplastic lesions. disease(n = 317)	Borderline ovarian tumor (n = 42)	Epithelial OC (n = 122)	Non-epithelial OC (n = 25)	Ovarian metastases(n = 22)
Age, in years^† † Values expressed as mean (standard deviation).	46.79 (16.17)	48.37 (16.22)	59.22 (14.42)	43.58 (18.17)	53.45 (11.08)
Premenopausal, n (%)	177 (55.84)	20 (47.62)	30 (24.59)	14 (56.0)	11 (50)
Postmenopausal, n (%)	140 (44.16)	22 (52.38)	92 (75.41)	11 (44.0)	11 (50)
Body Mass Index, in Kg/m²^† † Values expressed as mean (standard deviation).	28.57 (5.79)	28.67 (5.49)	27.17 (5.76)	28.42 (6.51)	27.43 (4.93)
CA125, in U/ml^† † Values expressed as mean (standard deviation).	67.39 (214.59)	167.55 (238.25)	1156.73 (3353.65)	156.13 (258.19)	532.68 (1469.04)
Platelets/nl^† † Values expressed as mean (standard deviation).	269,712.9 (74,493.58)	285,023.8 (69,662.42)	339,606.6 (115,450.86)	337,520.0 (153,029.99)	360,727.3 (153,945.01)
Neutrophil to lymphocyte ratio^† † Values expressed as mean (standard deviation).	2.20 (1.35)	2.87 (2.43)	3.81 (3.22)	2.63 (1.50)	9.43 (15.03)
Platelet to lymphocyte ratio^† † Values expressed as mean (standard deviation).	131.08 (56.23)	170.46 (123.62)	217.17 (155.09)	183.69 (95.35)	311.09 (218.70)
Disease stage
I-II, n (%)		35 (83.3)	58 (47.54)	24 (96)
III-IV, n (%)		7 (16.7)	64 (52.46)	1 (4)

	Sensitivity	Specificity	PPV	NPV	Positive LR	Negative LR	Accuracy	Accuracy 2^* * Accuracy for the differentiation of benign masses from borderline or stage I ovarian cancer (stage II or higher not included in this analysis).
CA125 ≥ 35 U/mL	61.90% (56.52 to 67.28)	84.98% (79.72 to 90.25)	73.45%	76.88%	4.12	0.45	75.72%	72.6%
PLT ≥ 350/nL	37.91% (32.57 to 43.25)	84.86% (78.65 to 91.07)	62.5%	67.25%	2.50	0.73	66.10%	69.1%
PLT ≥ 400/nL	25.59% (20.79 to 30.40)	96.21% (91.61 to 100.82)	81.82%	66.02%	6.76	0.77	67.99%	73.9%
PLR ≥ 150.9	57.82% (52.38 to 63.26)	75.08% (69.10 to 81.06)	60.70%	72.78%	2.32	0.56	68.18%	68.0%
NLR ≥ 2.9	42.65% (37.21 to 48.10)	85.17% (79.22 to 91.12)	65.69%	69.05%	2.88	0.67	68.18%	71.3%
CA125 ≥ 35 U/mL or PLT ≥ 350/nL	70.14% (65.08 to 75.20)	71.66% (65.92 to 77.39)	62.45%	78.12%	2.47	0.42	71.05%	66.4%
CA125 ≥ 35 U/mL or PLT ≥ 400/nL	67.30% (62.10 to 72.49)	81.79% (76.43 to 87.15)	71.36%	78.77%	3.69	0.40	75.95%	72.6%
CA125 ≥ 35 U/mL and PLT ≥ 350/nL	29.52% (24.49 to 34.55)	98.10% (94.86 to 101.34)	91.18%	67.68%	15.55	0.72	70.72%	75.2%
CA125 ≥ 35 U/mL and PLT ≥ 400/nL	20% (15.60 to 24.40)	99.37% (97.03 to 101.71)	95.45%	65.22%	31.7	0.80	67.74%	74.0%
CA125 ≥ 35 U/mL or PLR ≥ 150.9	76.30% (71.61 to 80.99)	64.87% (59.20 to 70.55)	59.19%	80.39%	2.17	0.36	69.45%	65.0%
CA125 ≥ 35 U/mL and PLR ≥ 150.9	43.33% (37.85 to 48.81)	95.22% (91.16 to 99.28)	85.85%	71.53%	9.07	0.59	74.43%	75.6%
CA125 ≥ 35 U/mL or NLR ≥ 2.9	71.09% (66.08 to 76.10)	73.89% (68.23 to 79.54)	64.66%	79.18%	2.72	0.39	72.77%	68.8%
CA125 ≥ 35 U/mL and NLR ≥ 2.9	33.33% (28.14 to 38.53)	96.20% (92.07 to 100)	85.36%	68.47%	8.8	0.69	71.10%	75%

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[1] Address for correspondence Adriana Yoshida, MD, PhD, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil (e-mail: adriana122013@gmail.com).