Predictive Value of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and CA-125 Dynamics After Neoadjuvant Chemotherapy for Surgical Outcomes and Prognosis in Ovarian Cancer

Asmaa S. Othman, Oncology Center, Faculty of Medicine, Mansoura University, Egypt
Hend M. Serya, Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt
Manar H. Ahmed, Oncology Center, Faculty of Medicine, Mansoura University, Egypt
Asmaa F. Elfayoumey, Oncology Center, Faculty of Medicine, Mansoura University, EgyptFollow

Corresponding Author

Asmaa F. Elfayoumey

Subject Area

Hematology and oncology

Article Type

Original Study

Abstract

Background: The prognosis of patients with advanced-stage epithelial ovarian cancer (EOC) having debulking surgery is greatly influenced by optimal resection. Neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and CA-125 values are examples of inflammatory markers that have been identified as possible predictive markers.

Objective: This study evaluated neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and CA-125 dynamics as predictors of surgical outcomes and survival in advanced ovarian cancer patients receiving neoadjuvant chemotherapy (NACT).

Methods: We conducted a retrospective analysis of 171 patients treated at Mansoura University (2020-2025) with platinum-taxane neoadjuvant chemotherapy followed by interval debulking surgery (IDS). Pre- and post-neoadjuvant chemotherapy inflammatory markers (neutrophil lymphocyte ratio, platelet lymphocyte ratio, eosinophil lymphocyte ratio [ELR], monocyte lymphocyte ratio [MLR]) and CA-125 levels were assessed. Surgical outcomes were classified as optimal (residual disease ≤1 cm) or suboptimal resection.

Results: Among 171 patients, optimal cytoreduction was achieved in 78.7% of patients. Significant changes in NLR, PLR, and CA-125 were observed after NACT (p < 0.001). High-grade serous histology and the number of neoadjuvant chemotherapy (NACT) cycles were independent factors associated with optimal resection. Progression-free survival (PFS) was independently predicted by changes in CA125 and MLR following NACT. While overall survival is strongly predicted by optimal resection.

Conclusion: Neutrophil lymphocyte ratio and platelet lymphocyte ratio are accessible biomarkers for predicting surgical outcomes after neoadjuvant chemotherapy, while CA-125 kinetics and monocyte lymphocyte ratio may inform survival prognostication. These findings support the integration of inflammatory markers into clinical decision-making for advanced ovarian cancer.

Recommended Citation

Othman, Asmaa S.; Serya, Hend M.; Ahmed, Manar H.; and Elfayoumey, Asmaa F. (2026) "Predictive Value of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and CA-125 Dynamics After Neoadjuvant Chemotherapy for Surgical Outcomes and Prognosis in Ovarian Cancer," Mansoura Medical Journal: Vol. 55 : Iss. 6 , Article 5.
Available at: https://doi.org/10.58775/2735-3990.1567