Selen Sevgi, Kilic Fatih, Kimyon Comert Gunsu, Unsal Mehmet, Kilic Cigdem, Karalok Alper, Turkmen Osman, Turan Taner
Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
J Obstet Gynaecol Res. 2020 Jul;46(7):1148-1156. doi: 10.1111/jog.14314. Epub 2020 May 28.
The aim of this study was to identify the differences between complex atypical hyperplasia/endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid-type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer.
Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid-type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut-off values found in the ROC analysis.
The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut-off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively.
The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions.
本研究旨在确定复杂非典型增生/子宫内膜上皮内瘤变（CAH/EIN）与1级子宫内膜样癌在术前全身炎症标志物方面的差异，并评估这些标志物在预测癌症方面的有效性。
2005年1月至2018年9月，共有372例最终组织病理学诊断为CAH/EIN（n = 143）和1级子宫内膜样癌（n = 229）的患者纳入本研究。中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）和血小板分布宽度（PDW）用作术前炎症标志物。采用受试者工作特征（ROC）分析评估NLR、PLR和PDW值对两组的诊断预测能力。根据ROC分析中找到的临界值对患者重新分组，进行单因素和多因素逻辑回归分析。
单因素分析显示，高龄、PDW降低以及PLR降低可能是癌症的预测因素。PDW的临界值为≤48.9%，PLR的临界值为≤133.3。经ROC分析确定的值在鉴别1级子宫内膜样癌时，PDW和PLR具有统计学意义。对于PDW，敏感性、特异性、阳性预测值和阴性预测值分别为52.8%、62.2%、68.9%和45.5%（P = 0.001）；对于PLR，分别为55.9%、59.4%、68.8%和45.7%（P = 0.005）。多因素分析中，高龄（>53岁）、低PDW（≤48.9%）和低PLR（≤133.3）在鉴别1级子宫内膜样癌与CAH/EIN的诊断预测中，与统计学显著的优势比相关，分别为8.01（P < 0.001）、1.79（P = 0.019）和1.73（P = 0.025）。
术前血液参数中的PLR和PDW值可用于区分子宫内膜癌与癌前病变。
