Systemic Inflammatory Biomarkers as a Predictive Markers for Ovarian Cancer

Andi Kurniadi,1 Steven Ridwan,1 Yudi Mulyana Hidayat,1 Syahrul Rauf,2 Kemala Isnainiasih Mantilidewi,1 Gatot NA Winarno,1 Siti Salima,1 Dodi Suardi1 1Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Obstetrics and Gynecology, Universitas Hasanuddin, Makassar, IndonesiaCorrespondence: Kemala Isnainiasih Mantilidewi, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281220828092, Email [email protected]: Tumor markers such as CA125 are highly beneficial in predictive ovarian malignancy; however, this advanced test is not always available in remote areas. To address this issue, the author aimed to explore the use of systemic inflammatory biomarkers as complementary modalities for diagnosis of ovarian malignancy.Methods: This diagnostic study utilized a cross-sectional approach, with outcomes measured by AUC and sensitivity. A total of 132 patients with adnexal tumors were consecutively included and measured a complete blood count. From this, the MLR (Monocyte Lymphocyte Ratio), NLR (Neutrophil Lymphocyte Ratio), PLR (Platelet Lymphocyte Ratio), SII (Systemic Immune Inflammation Index), and SIRI (Systemic Inflammatory Response Index) biomarkers were calculated. After surgery, histopathological examination was performed as the gold standard and the biomarker predictions were then compared to it, followed by statistical analysis.Results: The AUC values for MLR, NLR, PLR, SII, and SIRI were 0.70, 0.731, 0.696, 0.743, and 0.722, respectively. The p-values were MLR (0.005), NLR (0.001), PLR (0.001), SII (< 0.001), and SIRI (< 0.001), respectively. In multivariate analysis, only SII was significant (p = 0.015). The Exp(B) and 95% CI were 5.472 (1.383– 21.655). The validity test for SII showed satisfactory results: sensitivity 71.64%, specificity 73.84%, PPV 73.84%, NPV 71.64%, accuracy 72.72%, LR+ 2.74%, and LR- 0.38%.Conclusion: Systemic inflammatory biomarkers, particularly SII may aid in the predictive markers of early ovarian with diagnostic values nearly as good as CA125 (sensitivity 71.64% vs 75.97%). These biomarkers can serve as complementary predictive markes modalities for ovarian malignancy, especially when advanced tumor marker tests like CA125 are not available in remote areas.Keywords: MLR, NLR, PLR, SII, SIRI, ovarian malignancy