The role of changes in systemic inflammatory response markers during neoadjuvant chemotherapy in predicting suboptimal surgery in ovarian cancer

Curr Probl Cancer. 2020 Aug;44(4):100536. doi: 10.1016/j.currproblcancer.2020.100536. Epub 2020 Jan 15.


Aim: The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC).

Method: Patients who underwent IDS after neoadjuvant chemotherapy (NAC) for stage IIIC-IVA serous OC at 3 centers between January 2008 and March 2018 were analyzed retrospectively. All women with complete blood counts both at diagnosis (T0) and after the completion of NAC but prior to IDS (T1) were included. An average of 3 weeks passed between IDS and the last cycle of NAC.

Results: A total of 214 patients were found suitable for the study. Suboptimal surgery was performed in 25.2% of the patients and optimal surgery was performed in 74.8%. The rate of change in NLR was calculated as [(NLR T0 - NLR T1)/NLR T0] × 100. A higher rate of change in NLR was found in the optimal surgery group. Recovery of thrombocytosis (When platelet count before NAC was >400,000/mm3, recovery of thrombocytosis was defined as ≤400,000/mm3 after NAC.) was found to have 85.7% sensitivity and 64.8% specificity in predicting suboptimal surgery (P < 0.001). According to both multivariate and univariate regression analysis, a large change in NLR (>17%) and recovery of thrombocytosis significantly predicted suboptimal surgery.

Conclusion: To identify the likelihood of suboptimal surgery in advanced stage OC patients who undergo IDS after NAC, the dynamic change in NLR values can be examined.

Keywords: Interval debulking surgery; Neoadjuvant chemotherapy; Neutrophil-to-lymphocyte ratio; Ovarian cancer; Suboptimal surgery; Systemic inflammatory response markers; Thrombocytosis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammation Mediators / metabolism*
  • Middle Aged
  • Neoadjuvant Therapy / methods*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery*
  • Ovarian Neoplasms / therapy
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Systemic Inflammatory Response Syndrome / diagnosis*
  • Systemic Inflammatory Response Syndrome / etiology
  • Systemic Inflammatory Response Syndrome / metabolism


  • Inflammation Mediators