Superiority of MLR Over NLR and PLR In Predicting Advanced Stage Disease In Treatment-Naive Serous Ovarian Cancer

Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory. This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer.Material and methods: NLR, PLR, and MLR were calculated from preoperative blood samples of 63 treatment-naive ovarian cancer patients (58 serous, 92.1%) who underwent primary debulking surgery. FIGO 2021 staging criteria were used. Mann-Whitney U and Kruskal-Wallis tests (with Bonferroni correction) were used for intergroup comparisons; multivariate logistic regression analysis was applied to determine independent predictors. The discriminative performance of MLR was evaluated using ROC analysis.Results: 92.1% of the cohort had serous histology, and 61.9% had advanced-stage disease (FIGO stages III-IV). In multivariate analysis (adjusted for age and menopause), only MLR was found to be independently associated with advanced-stage disease (adjusted OR: 4.25; 95% CI: 1.24-14.49; p=0.021). NLR and PLR showed no significance. MLR was also associated with peritoneal metastasis (p=0.017) and intestinal infiltration (p=0.019). In ROC analysis, the AUC was 0.706 (95% CI: 0.567-0.845; p=0.006). The optimal cut-off value was determined as 0.30 (sensitivity 48.7%, specificity 91.7%); an alternative cut-off value of 0.17 (sensitivity 82.1%, specificity 50.0%) was evaluated for high sensitivity. Conclusion: In treatment-naive serous ovarian cancer, MLR demonstrated superior performance compared to NLR and PLR in predicting advanced disease and peritoneal metastasis (adjusted OR: 4.25; AUC: 0.706). This finding supports the clinical significance of the monocyte-macrophage axis in serous ovarian cancer with predominantly transcoelomic spread. The prognostic value and optimal cut-off values of MLR should be confirmed by prospective multicenter studies.