Association of preoperative inflammatory and nutritional serum markers with post-surgical outcomes in advanced epithelial ovarian cancer patients undergoing primary cytoreductive surgery

Authors

  • Shamim Ara Department of Obstetrics and Gynaecology, Directorate General of Health, Services (DGHS), Dhaka, Bangladesh
  • Jesmin Sultana Department of Gynaecological Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
  • Liza Tasrin Department of Obstetrics and Gynaecology, Bangladesh Secretariat Clinic, Dhaka, Bangladesh
  • Ayesha Siddika Purabi Department of Obstetrics and Gynaecology, Dhaka Medical College, Hospital, Dhaka, Bangladesh
  • M. Boyez Uddin Department of Anaesthesia, 300 Bedded Hospital, Khanpur, Narayanganj, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260162

Keywords:

Epithelial ovarian cancer, Neutrophil-to-lymphocyte ratio, Serum albumin, Cytoreductive surgery

Abstract

Background: Advanced epithelial ovarian cancer typically presents at later stages, contributing to high morbidity and mortality. Simple, inexpensive biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and serum albumin may help predict postoperative outcomes, particularly in low-resource settings. This study aimed to evaluate the association of preoperative inflammatory and nutritional serum markers with postoperative outcomes among women undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer.

Methods: A descriptive observational study was conducted at Dhaka Medical College Hospital from July 2021 to June 2022, including 50 women with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. Preoperative NLR and serum albumin were measured and categorized (NLR <3.4 vs ≥3.4; albumin ≥3.5 g/dL vs <3.5 g/dL). Postoperative complications within 30 days and the length of hospital stay were recorded. Statistical analyses included Chi-square tests and t-tests, with p<0.05 considered significant.

Results: Elevated NLR (≥3.4) was significantly associated with higher rates of wound infection requiring secondary suturing and increased postoperative blood transfusion. Similarly, hypoalbuminemia (<3.5 g/dL) was strongly associated with postoperative wound complications and higher transfusion needs. Both elevated NLR and low albumin were significantly correlated with prolonged hospital stay.

Conclusions: Preoperative NLR and serum albumin are valuable predictors of postoperative morbidity and recovery after primary cytoreductive surgery for advanced epithelial ovarian cancer. These readily accessible biomarkers can enhance preoperative risk stratification and guide optimization strategies to improve surgical outcomes.

Metrics

Metrics Loading ...

References

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA cancer J Clin. 2018;68(1):7-30. DOI: https://doi.org/10.3322/caac.21442

Yoneda A, Lendorf ME, Couchman JR, Multhaupt HA. Breast and ovarian cancers: a survey and possible roles for the cell surface heparan sulfate proteoglycans. Journal Histochem Cytochem. 2012;60(1):9-21. DOI: https://doi.org/10.1369/0022155411428469

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. DOI: https://doi.org/10.3322/caac.21660

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA cancer J Clin. 2018;68(6):394-424. DOI: https://doi.org/10.3322/caac.21492

The Global Cancer Observatory 2020. Bangladesh, International Agency for Research on Cancer. WHO.

Robinson TN, Wallace JI, Wu DS, Wiktor A, Pointer LF, Pfister SM, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213(1):37-42. DOI: https://doi.org/10.1016/j.jamcollsurg.2011.01.056

Erekson EA, Ratner ES, Walke LM, Fried TR. Gynecologic surgery in the geriatric patient. Obstet Gynecol. 2012;119(6):1262-9. DOI: https://doi.org/10.1097/AOG.0b013e31825715a9

Al Hilli MM, Tran CW, Langstraat CL, Martin JR, Weaver AL, McGree ME, et al. Risk-scoring model for prediction of non-home discharge in epithelial ovarian cancer patients. J Am Coll Surg. 2013;217(3):507-15. DOI: https://doi.org/10.1016/j.jamcollsurg.2013.04.036

Zhou Q, Hong L, Zuo MZ, He Z. Prognostic significance of neutrophil to lymphocyte ratio in ovarian cancer: evidence from 4,910 patients. Oncotarget. 2017;8(40):68938-49.

Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9(1):69. DOI: https://doi.org/10.1186/1475-2891-9-69

Schwegler I, Von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97(1):92-7. DOI: https://doi.org/10.1002/bjs.6805

Wang YQ, Jin C, Zheng HM, Zhou K, Shi BB, Zhang Q, et al. A novel prognostic inflammation score predicts outcomes in patients with ovarian cancer. Clin Chim Acta. 2016;456:163-9. DOI: https://doi.org/10.1016/j.cca.2016.03.013

Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79(5):1085-91. DOI: https://doi.org/10.1016/j.urology.2011.11.070

Xu J, Ni C, Ma C, Zhang L, Jing X, Li C, et al. Association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with ER and PR in breast cancer patients and their changes after neoadjuvant chemotherapy. Clin Transl Oncol. 2017;19(8):989-96. DOI: https://doi.org/10.1007/s12094-017-1630-5

Ballmer PE, Ochsenbein AF, Schütz-Hofmann S. Transcapillary escape rate of albumin positively correlates with plasma albumin concentration in acute but not in chronic inflammatory disease. Metabolism. 1994;43(6):697-705. DOI: https://doi.org/10.1016/0026-0495(94)90117-1

Kumar A, Torres ML, Cliby WA, Kalli KR, Bogani G, Aletti G, et al. Inflammatory and nutritional serum markers as predictors of peri-operative morbidity and survival in ovarian cancer. Anticancer Res. 2017;37(7):3673-7. DOI: https://doi.org/10.21873/anticanres.11738

Demir A, Alan O, Koca S, Surmeli H. The relationship between the prognostic nutritional index and overall survival in elderly patients with epithelial ovarian cancer. EJMI. 2020;4(2):269-73. DOI: https://doi.org/10.14744/ejmi.2020.30288

Zhang W, Ye B, Liang W, Ren Y. Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer. Sci Rep. 2017;7(1):9548. DOI: https://doi.org/10.1038/s41598-017-10328-8

Zhou Q, Hong L, Zuo MZ, He Z. Prognostic significance of neutrophil to lymphocyte ratio in ovarian cancer: evidence from 4,910 patients. Oncotarget. 2017;8(40):68938-49. DOI: https://doi.org/10.18632/oncotarget.20196

Ataseven B, du Bois A, Reinthaller A, Traut A, Heitz F, Aust S, et al. Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery. Gynecol Oncol. 2015;138(3):560-5. DOI: https://doi.org/10.1016/j.ygyno.2015.07.005

John-Olabode SO, Okunade KS, Olorunfemi G, Soibi-Harry A, Rimi G, Osunwusi B, et al. Pretreatment neutrophil-to-lymphocyte ratio: a prognostic biomarker of survival in patients with epithelial ovarian cancer. Cureus. 2021;13(7):e 16429. DOI: https://doi.org/10.7759/cureus.16429

Kumar A, Janco JM, Mariani A, Bakkum-Gamez JN, Langstraat CL, Weaver AL, et al. Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer. Gynecol Oncol. 2016;140(1):15-21. DOI: https://doi.org/10.1016/j.ygyno.2015.10.025

Zhang WW, Liu KJ, Hu GL, Liang WJ. Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients. Tumor Biol. 2015;36(11):8831-7. DOI: https://doi.org/10.1007/s13277-015-3533-9

Tsai PL, Su WJ, Leung WH, Lai CT, Liu CK. Neutrophil–lymphocyte ratio and CEA level as prognostic and predictive factors in colorectal cancer: A systematic review and meta-analysis. J Cancer Res Ther. 2016;12(2):582-9. DOI: https://doi.org/10.4103/0973-1482.144356

Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, et al. A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecol Oncol. 2007;107(1):99-106. DOI: https://doi.org/10.1016/j.ygyno.2007.05.032

Obermair A, Hagenauer S, Tamandl D, Clayton RD, Nicklin JL, Perrin LC, et al. Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol. 2001;83(1):115-20. DOI: https://doi.org/10.1006/gyno.2001.6353

Kim J, Shim SH, Oh IK, Yoon SH, Lee SJ, Kim SN, et al. Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery. Obstet Gynecol Sci. 2015;58(5):359-67. DOI: https://doi.org/10.5468/ogs.2015.58.5.359

Downloads

Published

2026-01-29

How to Cite

Ara, S., Sultana, J., Tasrin, L., Purabi, A. S., & Uddin, M. B. (2026). Association of preoperative inflammatory and nutritional serum markers with post-surgical outcomes in advanced epithelial ovarian cancer patients undergoing primary cytoreductive surgery. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(2), 454–459. https://doi.org/10.18203/2320-1770.ijrcog20260162

Issue

Section

Original Research Articles