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Volume 27
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Systemic Immune-Inflammatory Biomarkers in Epithelial Ovarian Cancer: Subgroup-Dependent Prognostic Performance and Integrated Risk Stratification

by
E Sun Paik
1,†,
Young Eun Chung
2,†,
Seoyoung Youn
1,
Seongyun Lim
2,
Jun-Hyeong Seo
2,
Chel Hun Choi
2,
Tae-Joong Kim
2,
Jeong-Won Lee
2 and
Yoo-Young Lee
2,*
1
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
2
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Int. J. Mol. Sci. 2026, 27(17), 7777; https://doi.org/10.3390/ijms27177777 (registering DOI)
Submission received: 24 July 2026 / Revised: 25 August 2026 / Accepted: 28 August 2026 / Published: 30 August 2026
(This article belongs to the Special Issue Molecular and Biomarker Advances in Gynecologic Oncology)
Review Reports Versions Notes

Abstract

Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are surrogate markers of the systemic immune-inflammatory response proposed as perioperative prognostic biomarkers in epithelial ovarian cancer (EOC), yet their performance across subgroups remains unexamined. In 373 EOC patients undergoing primary cytoreductive surgery, postoperative day-1 changes (ΔSII, ΔNLR, ΔPLR) were compared for overall survival (OS) and progression-free survival (PFS) across 10 subgroups, and a Clinical-Inflammatory Risk Score (CIRS) combining inflammation with stage and residual disease was developed. Individual markers showed modest discrimination (area under the curve [AUC] 0.579–0.615); the marker with the highest AUC varied by context, with ΔPLR ranking first most often, notably in non-serous tumors, though none was statistically superior. Seeking a molecular counterpart, two public transcriptomic cohorts were re-analyzed: VWF was consistently higher in clear cell than serous carcinoma, whereas IL6–STAT3-related differences were cohort-dependent. The CIRS achieved AUCs of 0.752 (OS) and 0.764 (PFS), a six-fold mortality gradient (7.2% vs. 44.4%), and remained independently associated with OS and PFS (hazard ratio 2.55 and 2.24 per standard deviation), though discrimination was not significantly better than stage and residual disease alone. These biomarkers show subgroup-dependent prognostic value, and the CIRS provides an exploratory risk-stratification framework warranting prospective validation.
Keywords: epithelial ovarian cancer; tumor microenvironment; systemic immune-inflammation index; prognostic biomarker; interleukin-6; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; inflammation epithelial ovarian cancer; tumor microenvironment; systemic immune-inflammation index; prognostic biomarker; interleukin-6; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; inflammation

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MDPI and ACS Style

Paik, E.S.; Chung, Y.E.; Youn, S.; Lim, S.; Seo, J.-H.; Choi, C.H.; Kim, T.-J.; Lee, J.-W.; Lee, Y.-Y. Systemic Immune-Inflammatory Biomarkers in Epithelial Ovarian Cancer: Subgroup-Dependent Prognostic Performance and Integrated Risk Stratification. Int. J. Mol. Sci. 2026, 27, 7777. https://doi.org/10.3390/ijms27177777

AMA Style

Paik ES, Chung YE, Youn S, Lim S, Seo J-H, Choi CH, Kim T-J, Lee J-W, Lee Y-Y. Systemic Immune-Inflammatory Biomarkers in Epithelial Ovarian Cancer: Subgroup-Dependent Prognostic Performance and Integrated Risk Stratification. International Journal of Molecular Sciences. 2026; 27(17):7777. https://doi.org/10.3390/ijms27177777

Chicago/Turabian Style

Paik, E Sun, Young Eun Chung, Seoyoung Youn, Seongyun Lim, Jun-Hyeong Seo, Chel Hun Choi, Tae-Joong Kim, Jeong-Won Lee, and Yoo-Young Lee. 2026. "Systemic Immune-Inflammatory Biomarkers in Epithelial Ovarian Cancer: Subgroup-Dependent Prognostic Performance and Integrated Risk Stratification" International Journal of Molecular Sciences 27, no. 17: 7777. https://doi.org/10.3390/ijms27177777

APA Style

Paik, E. S., Chung, Y. E., Youn, S., Lim, S., Seo, J.-H., Choi, C. H., Kim, T.-J., Lee, J.-W., & Lee, Y.-Y. (2026). Systemic Immune-Inflammatory Biomarkers in Epithelial Ovarian Cancer: Subgroup-Dependent Prognostic Performance and Integrated Risk Stratification. International Journal of Molecular Sciences, 27(17), 7777. https://doi.org/10.3390/ijms27177777

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