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Combined Plasma Fibrinogen and Neutrophil Lymphocyte Ratio in Ovarian Cancer Prognosis May Play a Role?
  1. Claudia Marchetti, PhD,
  2. Alessia Romito, MD,
  3. Angela Musella, MD,
  4. Giulia Santo, MD,
  5. Innocenza Palaia, PhD,
  6. Giorgia Perniola, PhD,
  7. Violante Di Donato, MD,
  8. Ludovico Muzii, PhD and
  9. Pierluigi Benedetti Panici, PhD
  1. Department of Ginecological-Obstetrical and Urological Sciences, Sapienza University, Rome, Italy.
  1. Address correspondence and reprint requests to Claudia Marchetti, PhD, Department of Ginecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. E-mail: clamarchetti81{at}


Objectives In ovarian cancer (OC), approximately 70% will relapse within 12 months from diagnosis; inflammation plays an important role in cancer initiating and progression; thus, a combination of neutrophil-to-lymphocyte ratio (NLR) and fibrinogen (F-NLR) has been proposed as prognostic marker in several tumors. The aim of our study was to investigate the correlation between NLR, fibrinogen, and F-NLR and survival in OC population.

Methods Patients with diagnosis of OC admitted to our institute between 2011 and 2016 were included. Data about pretreatment complete blood count were collected. Neutrophil-to-lymphocyte ratio was defined as the absolute neutrophil count divided by the absolute lymphocyte count; the F-NLR score was 0 for low NLR and fibrinogen, 1 for low NLR and high fibrinogen, or, conversely, 2 for both high markers. We correlated this index with progression-free survival.

Results A total of 94 patients were enrolled. Median age at diagnosis was 55 (34–83) years; more than 80% of patients presented International Federation of Gynecology and Obstetrics stage III–IV at diagnosis, and 72 (77%) presented high-grade serous histology. Primary debulking surgery was performed in 57 women (60%), whereas 37 (40%) underwent interval debulking surgery.

Mean serum NLR was 5.25 ± 5.37, and mean serum fibrinogen value was 4.19 ± 0.97 g/L. The median follow-up time was 27 months (range, 8–60 months). All patients with F-NLR value of 2 presented advanced disease compared with 64% of those with F-NLR of 0 (P < 0.031); these patients more frequently required neoadjuvant chemotherapy (P < 0.003) and more often had platinum-resistant disease (P < 0.022). Patients with high F-NLR presented worse progression-free survival than did patients with low F-NLR (12 vs 42 months, respectively, P = 0.023).

Conclusions Combining NLR and fibrinogen levels could be used as a factor for prediction of prognosis and response to treatment in patients affected with OC.

  • Fibrinogen
  • Neutrophil-to-lymphocyte ratio
  • Ovarian cancer
  • Prognosis

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  • The authors declare no conflicts of interest.