High pre-and post-treatment Platelet-Neutrophil to Lymphocyte ratio is linked to high mortality risk in Epithelial Ovarian Cancer patients in Southeastern Nigeria

Introduction: To identify risk factors and prognostic tools for epithelial ovarian cancer (EOC), an aggressive ovarian cancer, this study assessed the frequency of BRCA2 mutation in early-onset ( 50 years old) and late-onset (> 50 years old) EOC and variation of systemic immune-inflammatory indices, especially among herbal medicine- and chemotherapy-experienced patients. Methods: This study included 100 patients diagnosed with EOC from Jan. 2016 to Dec. 2021. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelets-neutrophils-to-lymphocytes ratio (PNLR), and neutrophils-to-lymphocytes platelets ratio (NLPR) were assessed and analyzed accordingly. Significance was set at p< 0.05. Result: The frequency of early menarche, serous adenocarcinoma, in-hospital death, and late-stage disease was 3.3, 1.6, 1.7, and 1.4 times higher among patients with early-onset EOC compared with their late-onset counterparts (p= 0.001, 0.025, 0.063, and 0.397, respectively). The frequency of BRCA2 mutation, hypertension, and diabetes was 2.5, 2.5, and 5.7 times higher among the latter than among the former (p= 0.001, 0.006, and 0.064, respectively). The pre-/post-treatment PNLR were 1.7/2.3 times significantly higher in cases of in-hospital death (1016.0  169.4/ 750.5  193.2) than in patients who were stable on discharge (591.60  25.3/325.3  35.3 at p= 0.044 and 0.013, respectively. There was a significant decline of pre-to-post-chemotherapy PNLR in the Stages I/II cases and an insignificant decline in Stages III/IV cases (p= 0.003 and 0.433, respectively). The post-treatment PNLR, PLR, and TWBC of herbal medicine-experienced patients were 5.6, 1.6, and 1.5, higher than the post-treatment values of naïve counterparts, respectively (p< 0.05). Conclusion: This study revealed a high frequency of aggressive early-onset EOC and a higher frequency of BRCA2 mutation in late-onset EOC. It also revealed better treatment outcomes among patients who received at least four courses of chemotherapy and poor treatment outcomes among patients with a history of herbal medicine uptake. It suggests that NLR, PNLR, and PLR could be used to monitor disease progression.