Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yeongun-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea.
Eur J Surg Oncol. 2010 Jul;36(7):691-8. doi: 10.1016/j.ejso.2010.05.004. Epub 2010 Jun 8.
Uterine sarcomas are rare among all uterine malignancies, and frequently misdiagnosed as benign uterine diseases such as leiomyoma and adenomyosis because of lack of feasible tools for the preoperative diagnosis. Although some studies have suggested the role of serum CA-125 levels for the preoperative diagnosis, the efficacy is controversial. Since malignancy is known to be associated with systemic inflammation which leads to hematological alteration, we compared the efficacy for the preoperative diagnosis of uterine sarcomas between the neutrophil to lymphocyte ratio (NLR) and serum CA-125 levels using a case-match comparison.
From November 2004 to December 2008, 55 patients with carcinosarcoma (n=21), leiomyosarcoma (n=20) and endometrial stromal sarcoma (n=14) were matched to 330 patients with leiomyoma (n=165) and adenomyosis (n=165) in terms of age at diagnosis, body mass index and uterine volume.
The receiver operating characteristic curve showed the best cut-off values of the NLR (>or=2.12) and serum CA-125 levels (>or=27.5U/ml) for the preoperative diagnosis of uterine sarcomas, demonstrating that the NLR was more powerful for the preoperative diagnosis of uterine sarcomas than serum CA-125 levels (sensitivity, 74.5% vs. 52.3%; specificity, 70.3% vs. 50.5%; positive predictive value, 29.5% vs. 15.1%; negative predictive value, 94.3% vs. 86.5%; accuracy, 60.6% vs. 49.6%; p<0.05). Furthermore, the NLR reflected recurrence and progression more accurately than serum CA-125 levels in patients with uterine sarcomas.
These findings suggest that the NLR may be more useful than serum CA-125 levels as a cost-effective tool for the preoperative diagnosis in patients with uterine sarcomas.
在所有的子宫恶性肿瘤中，子宫肉瘤较为罕见，由于缺乏可行的术前诊断工具，常被误诊为良性子宫疾病，如平滑肌瘤和子宫腺肌病。虽然一些研究表明血清 CA-125 水平对术前诊断有一定作用，但疗效存在争议。由于恶性肿瘤与全身性炎症有关，导致血液学改变，我们通过病例匹配比较，比较了中性粒细胞与淋巴细胞比值（NLR）和血清 CA-125 水平对术前诊断子宫肉瘤的疗效。
2004 年 11 月至 2008 年 12 月，55 例癌肉瘤（n=21）、平滑肌肉瘤（n=20）和子宫内膜间质肉瘤（n=14）患者与 330 例平滑肌瘤（n=165）和子宫腺肌病（n=165）患者按诊断时年龄、体重指数和子宫体积进行匹配。
受试者工作特征曲线显示 NLR（>或=2.12）和血清 CA-125 水平（>或=27.5U/ml）对术前诊断子宫肉瘤的最佳截断值，表明 NLR 对术前诊断子宫肉瘤的作用优于血清 CA-125 水平（敏感性，74.5%比 52.3%；特异性，70.3%比 50.5%；阳性预测值，29.5%比 15.1%；阴性预测值，94.3%比 86.5%；准确性，60.6%比 49.6%；p<0.05）。此外，NLR 比血清 CA-125 水平更能准确反映子宫肉瘤患者的复发和进展。
这些发现表明，NLR 可能比血清 CA-125 水平更有用，作为一种具有成本效益的工具，用于术前诊断子宫肉瘤患者。
