What does this research mean for the field?

In treatment-naive serous ovarian cancer, the monocyte-lymphocyte ratio (MLR) is an independent predictor of advanced-stage disease and peritoneal metastasis, demonstrating superior predictive performance compared to the neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 2, 2026Open Access

Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer

Key Points

This study compares the prognostic value of monocyte-lymphocyte ratio (MLR) versus neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in predicting advanced stage disease and metastasis in serous ovarian cancer.
Analyzed preoperative blood samples from 63 treatment-naive ovarian cancer patients.
Calculated MLR, NLR, and PLR, and applied multivariate logistic regression to identify independent predictors.
Used ROC analysis to evaluate the performance of MLR compared to NLR and PLR.
MLR showed a significant association with advanced-stage disease (adjusted OR: 4.25; 95% CI: 1.24-14.49; p=0.021).
NLR and PLR were not statistically significant predictors.
ROC analysis indicated MLR had an AUC of 0.706 (95% CI: 0.567-0.845; p=0.006) with optimal cut-off values identified.

Abstract

Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory. This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer.Material and methods: NLR, PLR, and MLR were calculated from preoperative blood samples of 63 treatment-naive ovarian cancer patients (58 serous, 92.1%) who underwent primary debulking surgery. FIGO 2021 staging criteria were used. Mann-Whitney U and Kruskal-Wallis tests (with Bonferroni correction) were used for intergroup comparisons; multivariate logistic regression analysis was applied to determine independent predictors. The discriminative performance of MLR was evaluated using ROC analysis.Results: 92.1% of the cohort had serous histology, and 61.9% had advanced-stage disease (FIGO stages III-IV). In multivariate analysis (adjusted for age and menopause), only MLR was found to be independently associated with advanced-stage disease (adjusted OR: 4.25; 95% CI: 1.24-14.49; p=0.021). NLR and PLR showed no significance. MLR was also associated with peritoneal metastasis (p=0.017) and intestinal infiltration (p=0.019). In ROC analysis, the AUC was 0.706 (95% CI: 0.567-0.845; p=0.006). The optimal cut-off value was determined as 0.30 (sensitivity 48.7%, specificity 91.7%); an alternative cut-off value of 0.17 (sensitivity 82.1%, specificity 50.0%) was evaluated for high sensitivity. Conclusion: In treatment-naive serous ovarian cancer, MLR demonstrated superior performance compared to NLR and PLR in predicting advanced disease and peritoneal metastasis (adjusted OR: 4.25; AUC: 0.706). This finding supports the clinical significance of the monocyte-macrophage axis in serous ovarian cancer with predominantly transcoelomic spread. The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.

Read Full Paperexternally

Mark Helpful

Bookmark

Relay

View Full Paper