The Effect of Neutrophil-to-Lymphocyte Ratio on Prognosis in Malignant Ovarian Germ Cell Tumors

<b>Background/Objectives</b>: Ovarian germ cell tumors are rare, and determining prognostic factors is crucial for individualizing management strategies. We aimed to determine an optimal neutrophil-to-lymphocyte ratio (NLR) cut-off value for predicting survival outcomes in malignant ovarian germ cell tumors, and to evaluate the prognostic significance of NLR in these tumors. <b>Methods</b>: This retrospective cohort study included women diagnosed with malignant ovarian germ cell tumors who underwent surgery at Istanbul University-Cerrahpasa between 2000 and 2024. Patients with benign tumors; incomplete follow-up; inaccessible data; history of hematological or rheumatic diseases; inflammatory conditions such as diabetes mellitus, asthma, or renal failure; as well as those with acute/chronic infections or sepsis were excluded. Data collected included demographic characteristics, surgical and pathological findings, chemotherapy details, disease progression, survival outcomes, and laboratory values at preoperative, postoperative, and post-chemotherapy time points. The NLR was calculated and compared for overall survival and disease-free survival. <b>Results</b>: The study included 44 patients with a pathologically confirmed diagnosis of malignant ovarian germ cell tumors. The NLR cut-off value for survival prediction was determined as 3.69 using the ROC curve. The effect of preoperative NLR on overall survival was found to be significant. The median overall survival was significantly lower in the group with NLR ≥ 3.69 (153.2 months) compared to the group with NLR < 3.69 (234 months) (<i>p</i> = 0.010). However, there was no statistically significant difference in median disease-free survival between the NLR ≥ 3.69 group (159.3 months) and the NLR < 3.69 group (215 months). <b>Conclusions</b>: The preoperative NLR was found to have a significant impact on overall survival but not on disease-free survival. A cut-off value of 3.69 can be used to assess short survival time.