The prognostic value of the lymph node ratio in patients with stage IIIC ovarian cancer treated with preoperative chemotherapy

Background: Ovarian cancer is a major cause of morbidity and mortality in females. Due to the unremarkable symptoms associated with early ovarian cancer, many patients are already in the advanced stages at first diagnosis. Recent studies have shown that the lymph node ratio (LNR) has a certain value in predicting the prognosis of patients with ovarian cancer. However, preoperative chemotherapy may lead to changes in the LNR, and thus, the predictive value of the LNR in such patients is unclear. Therefore, this study examined the predictive value of the LNR in ovarian cancer patients undergoing preoperative chemotherapy.

Methods: A total of 208 patients with stage IIIC ovarian cancer, who were treated in the Fourth Clinical Medical College of Xinxiang Medical University, Xinxiang Central Hospital from January 2014 to January 2016, were recruited for this study. The median LNR was 0.32. Patients with LNR <0.32 were defined as the control group and those with LNR ≥0.32 were defined as the observation group. The prognosis of the two groups was compared.

Results: The LNR in the observation group was significantly higher than that of the control group (0.63±0.21 vs. 0.19±0.08; P=0.000). Patients in the observation group showed significantly higher postoperative recurrence rates (51.92% vs. 22.12%; P=0.000), greater incidences of postoperative metastasis (43.27% vs. 17.31%; P=0.000), and significantly increased postoperative mortality (36.54% vs. 11.54%; P=0.000) compared to the control group. The survival function showed that the overall survival, recurrence-free survival, and metastasis-free survival were all significantly shorter in the observation group compared to the control group (P=0.000). The receiver operating characteristic curves showed that the LNR had certain diagnostic value for postoperative recurrence [area under the curve (AUC) =0.658; 95% confidence interval (CI): 0.582 to 0.734; P=0.000], postoperative metastasis (AUC =0.640; 95% CI: 0.560 to 0.720; P=0.001), and postoperative mortality (AUC =0.653; 95% CI: 0.569 to 0.737; P=0.001) in patients with stage IIIC ovarian cancer treated with preoperative chemotherapy.

Conclusions: The LNR has good prognostic value in patients with locally advanced ovarian cancer treated with preoperative chemotherapy.