SYSTEMATIC REVIEW article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1576586
Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis
Provisionally accepted
Ru-Meng Yang
Li-Wei Liu*- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Background: The Neutrophil-to-Lymphocyte Ratio (NLR) has surfaced as a prospective prognostic indicator in multiple cancers, including ovarian cancer. This systematic review and meta-analysis assess the prognostic relevance and clinical implications of NLR on outcomes such as Overall Survival (OS) and Progression-Free Survival (PFS) in patients with ovarian cancer. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, a comprehensive search was conducted on December 6, 2024, across prominent databases such as PubMed, Embase, Web of Science, and the Cochrane Library. The inclusion criteria emphasized observational studies evaluating the correlation between NLR and survival outcomes in ovarian cancer. Quality was evaluated using the Newcastle-Ottawa Scale, and data synthesis included both fixed-effect and random-effects models based on levels of heterogeneity. Results: The search yielded 1707 articles, of which 15 met the inclusion criteria. Meta-analysis showed that elevated NLR was associated with poorer overall survival (HR = 1.26, 95% CI: 1.12–1.39, P < 0.001) and progression-free survival (HR = 1.32, 95% CI: 1.14–1.50, P < 0.001), with substantial heterogeneity (I² > 50%). Subgroup analyses showed consistent associations across ethnicities, sample sizes, and NLR thresholds. Stronger effects were observed in Asian populations and with NLR cutoffs >3.5. Among histologic subtypes, the association was significant in serous carcinoma but not in clear cell carcinoma. Sensitivity analysis confirmed the stability of results, and no significant publication bias was detected. Conclusions: This meta-analysis identifies a significant association between high NLR and poorer OS and PFS in ovarian cancer patients, suggesting its potential utility as a prognostic indicator. While these findings support the consideration of NLR in risk stratification, further prospective studies are warranted before its routine incorporation into clinical management strategies.
Keywords: ovarian cancer, Neutrophil-to-Lymphia Ratio, Survival outcomes, prognosticindicator, Meta-analysis
Received: 14 Feb 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Yang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Li-Wei Liu, wyaae2@163.com
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