The Pretreatment Glucose-to-Lymphocyte Ratio as an Independent Prognostic Biomarker in Ovarian Cancer

<b>Background/Objectives</b>: This study aimed to assess the prognostic significance of the glucose-lymphocyte ratio (GLR) prior to therapy in individuals with epithelial ovarian cancer. <b>Methods</b>: This retrospective cohort study included 326 patients with epithelial ovarian cancer who were treated from 2011 to 2025. The GLR was computed utilizing pre-treatment fasting blood glucose levels and absolute lymphocyte numbers. The optimal GLR cutoff value was established by receiver operating characteristic (ROC) analysis. Overall survival (OS) and disease-free survival (DFS) were assessed utilizing Kaplan-Meier analysis and Cox regression models. Additional sensitivity analyses were performed excluding patients with diabetes mellitus and by testing the interaction between GLR and neoadjuvant chemotherapy. <b>Results</b>: The optimal GLR cutoff value was 3.42. Patients were classified into low-GLR (≤3.42; <i>n</i> = 190) and high-GLR (>3.42; <i>n</i> = 136) groups. Patients with high GLR levels (>3.42) had a median OS of 58 months, which was significantly shorter than the 151 months for patients with low GLR levels (≤3.42) (<i>p</i> < 0.001). They also had a median DFS of 17 months, which was significantly shorter than the 49 months for patients with low GLR levels (<i>p</i> < 0.001). Multivariable Cox regression analysis showed that a higher GLR is an independent prognostic factor related to shorter overall survival (HR: 1.561; 95% CI: 1.078-2.261; <i>p</i> = 0.018). Findings remained consistent after excluding patients with diabetes mellitus. The group with a high GLR had a greater rate of disease progression (55.1% vs. 29.5%, <i>p</i> < 0.001). <b>Conclusions</b>: The pre-treatment GLR may serve as a simple and readily available prognostic biomarker in epithelial ovarian cancer, potentially supporting basic risk stratification; however, external validation is required.