# The Pretreatment Glucose-to-Lymphocyte Ratio as an Independent Prognostic Biomarker in Ovarian Cancer

## TL;DR

This study shows that a high glucose-to-lymphocyte ratio before treatment is linked to worse survival in ovarian cancer patients.

## Contribution

The study identifies the glucose-to-lymphocyte ratio as a new independent prognostic biomarker for ovarian cancer.

## Key findings

- A high GLR was associated with significantly shorter overall and disease-free survival in ovarian cancer patients.
- Multivariable analysis confirmed GLR as an independent prognostic factor for shorter survival.
- Findings remained consistent even after excluding patients with diabetes mellitus.

## Abstract

Background/Objectives: This study aimed to assess the prognostic significance of the glucose-lymphocyte ratio (GLR) prior to therapy in individuals with epithelial ovarian cancer. Methods: This retrospective cohort study included 326 patients with epithelial ovarian cancer who were treated from 2011 to 2025. The GLR was computed utilizing pre-treatment fasting blood glucose levels and absolute lymphocyte numbers. The optimal GLR cutoff value was established by receiver operating characteristic (ROC) analysis. Overall survival (OS) and disease-free survival (DFS) were assessed utilizing Kaplan–Meier analysis and Cox regression models. Additional sensitivity analyses were performed excluding patients with diabetes mellitus and by testing the interaction between GLR and neoadjuvant chemotherapy. Results: The optimal GLR cutoff value was 3.42. Patients were classified into low-GLR (≤3.42; n = 190) and high-GLR (>3.42; n = 136) groups. Patients with high GLR levels (>3.42) had a median OS of 58 months, which was significantly shorter than the 151 months for patients with low GLR levels (≤3.42) (p < 0.001). They also had a median DFS of 17 months, which was significantly shorter than the 49 months for patients with low GLR levels (p < 0.001). Multivariable Cox regression analysis showed that a higher GLR is an independent prognostic factor related to shorter overall survival (HR: 1.561; 95% CI: 1.078–2.261; p = 0.018). Findings remained consistent after excluding patients with diabetes mellitus. The group with a high GLR had a greater rate of disease progression (55.1% vs. 29.5%, p < 0.001). Conclusions: The pre-treatment GLR may serve as a simple and readily available prognostic biomarker in epithelial ovarian cancer, potentially supporting basic risk stratification; however, external validation is required.