Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses.

Objective: We aimed to investigate the utility of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count as biomarkers to distinguish malignant from benign ovarian masses.

Material And Methods: We retrospectively reviewed the histopathological results of 185 benign and 33 malignant cases following surgery for an initial diagnosis of adnexal mass and confirmed ovarian masses. Age, cancer antigen 125 (CA-125), white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), mean platelet volume (MPV), platelet distribution width (PDW), NLR, PLR, and lymphocyte counts were compared between groups.

Results: The significant diagnostic factors to distinguish malignant from benign disease were age (35.5±22 vs. 62±13 years; p<0.001) and CA-125 levels (16.6±21 vs. 98±366 U/mL; p<0.001). No significant difference was observed in WBC count, Hct, Hb, platelet count, PDW, and MPV between groups. To distinguish malignant from benign masses, lymphocyte count (1.29±0.91 vs. 1.80±0.67×10(3) cells/μL, p<0.001), NLR (4.95±5.36 vs. 3.32±2.72, p=0.024), and PLR (203.41±107.84 vs. 160.75±70.84, p<0.001) were identified as markers. The cutoff values were lymphocyte count of >1500 cells/μL (p<0.001), NLR of 3.4732 (p=0.033), PLR of 161.13 (p<0.001), CA-125 of >40 U/mL (p<0.001), and age of >53 years (p<0.001); their respective sensitivity and specificity were 66.7% and 77.8% [area under the curve (AUC), 0.723±0.055], 68.8% and 54.1% (AUC, 0.624±0.058), 81.8% and 50.8% (AUC, 0.683±0.052), 78.8% and 77.8% (AUC, 0.797±0.057), and 81.8% and 82.2% (AUC, 0.888±0.025). Multiple logistic regression analysis revealed cutoff explanatory and accuracy values of 68.2% and 94.9%, respectively, for lymphocyte count, NLR, PLR, CA-125, and age as independent parameters to distinguish malignant from benign ovarian masses.

Conclusion: In combination with age and CA-125 levels, NLR, PLR, and lymphocyte count may be helpful to preoperatively distinguish malignant from benign ovarian masses.