Pre-operative platelet-to-lymphocyte ratio can help predict residual disease after primary debulking surgery for epithelial ovarian cancer.
Objective: The success of surgery in ovarian cancer is based on achieving complete cytoreduction. In order to achieve the best outcomes, patients are triaged into either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. Current methods using computed tomography (CT) scans have limited accuracy in predicting optimal cytoreduction outcomes. This study investigated whether pre-operative blood count markers of inflammation could predict optimal cytoreduction, aiding in the triaging decision.
Methods: We conducted a retrospective chart review of patients with ovarian cancer stage IIIc to IV, treated at two medical centers in Israel between 2003 and 2019. Patients were categorized into those undergoing primary operation and those receiving neoadjuvant chemotherapy followed by interval debulking surgery. Pre-operative complete blood counts were used to calculate neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Statistical analyses were used to determine optimal cutoff values of hematologic markers to predict the likelihood of achieving optimal cytoreduction.
Results: Overall, 282 women fit the inclusion criteria, of which 133 underwent primary surgery and 149 had interval debulking surgery. Platelet-lymphocyte ratio was the only hematologic marker found to be significantly correlated with patient designation based on CT scans. The platelet-lymphocyte ratio cutoff value of 177 was identified as the optimal threshold (area under the curve 0.628, 95% CI 0.562 to 0.693, p < .001). Patients with levels >177 had significantly lower rates of complete debulking (R0) compared to those with levels ≤177 (33.3% vs 52.9%, p = .023)
Conclusions: A platelet-lymphocyte ratio of 177 may serve as an adjunct marker alongside CT imaging in predicting optimal cytoreduction in ovarian cancer patients. Prospective studies are required to validate these findings and explore the integration of platelet-lymphocyte ratio into existing predictive models.