Baseline LDL-to-Monocyte Ratio as a Prognostic Biomarker in Advanced Inoperable Ovarian Cancer

Abstract

Objective: Studies have shown that higher levels of peripheral monocytes are associated with poorer survival rates in various advanced cancers, suggesting that they could serve as markers of an immune response that promotes tumor growth. Additionally, modified lipoproteins, particularly oxidized LDL, can directly activate monocytes. These findings highlight a complex interaction in which lipid availability and monocyte-driven inflammation may work together as part of a broader system that promotes tumor progression. Materials and Methods: This retrospective cohort study included patients diagnosed with stage III inoperable or stage IV epithelial ovarian cancer at initial presentation. Results: In the univariate analysis, a lower LDL-to-monocyte ratio (<256.3) was associated with significantly longer PFS compared with a ratio of ≥256.3 (20.4 vs. 11.2 months, p=0.018). In the Cox regression analysis, visceral metastasis (HR: 4.44, 95% CI: 0.79–24.94, p=0.091), stage (HR: 0.89, 95% CI: 0.11–7.25, p=0.913), LDL-to-monocyte ratio (HR: 0.986, 95% CI: 0.971–1.001, p=0.061), and BMI (HR: 0.939, 95% CI: 0.795–1.108, p=0.453) were not identified as independent prognostic factors for disease-free survival. Conclusion: We demonstrated that a lower LDL-to-monocyte ratio was associated with significantly longer progression-free survival in patients with advanced inoperable ovarian cancer. The LDL-to-monocyte ratio, as a noninvasive and easily measurable parameter, can be considered a marker of survival in patients with ovarian cancer; however, larger multicenter studies are needed to confirm these findings.