NLR and BRCA mutational status in patients with high grade serous advanced ovarian cancer

Laboratory-markers of the systemic inflammatory-response, such as neutrophil/lymphocyte-ratio (NLR) have been studied as prognostic factors in several tumors but in OC-patients their role is still controversial and no data about the possible correlation with the BRCA-status has been ever reported. We consecutively enrolled a series of 397 newly diagnosed high-grade serous-advanced OC-patients. All patients were tested for BRCA-mutational-status and blood-parameters have been collected 48 h before staging-surgery. A significant correlation of NLR with disease distribution (p<0.005) was found and patients with NLR<4 underwent primary-debulking-surgery more frequently (p-value 0.001), with a lower surgical-complexity-score (p-value 0.002). Regarding survival-data, patients with NLR<4 had a significant 7-month increase in mPFS (26 vs 19 months, p=0.009); focusing on the BRCA-status, among both BRCA-mutated and BRCA-wild type patients, those with lower NLR had a significantly prolonged mPFS compared to patients with NLR>4 (BRCA-mutated: 35 vs 23 months, p=0.03; BRCA-wt: 19 vs 16 months, p=0.05). At multivariate-analysis, independent factors of prolonged PFS were BRCA mutational status, having received complete cytoreduction and NLR<4. Also, the strongest predictors of longer OS were BRCA-mutational status, having received complete cytoreductive surgery, NLR<4 and age. NLR is confirmed to be a prognostic marker in OC-patients and it seems unrelated with BRCA-mutational status.

Automated summary

The study found that NLR is associated with disease distribution in ovarian cancer patients, with those having NLR<4 more likely to undergo primary debulking surgery and have lower surgical complexity scores. Patients with NLR<4 had a longer median Progression-Free Survival (mPFS), and both BRCA-mutated and BRCA-wild type patients with lower NLR had significantly prolonged mPFS compared to those with higher NLR. BRCA mutational status, complete cytoreduction, and NLR<4 were identified as independent factors of prolonged PFS, while BRCA mutational status, complete cytoreductive surgery, NLR<4, and age were predictors of longer Overall Survival (OS).