Kirsch-Mangu Alexandra Timea, Țîpcu Alexandru, Gâta Vlad Alexandru, Pop Diana Cristina, Fekete Zsolt, Irimie Alexandru, Kubelac Paul Milan
Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania.
Prof. Dr. I. Chiricută" Institute of Oncology, 400015 Cluj-Napoca, Romania.
Diagnostics (Basel). 2025 Aug 27;15(17):2172. doi: 10.3390/diagnostics15172172.
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Despite advances in diagnosis and treatment, recurrence and mortality remain significant concerns. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has shown prognostic value in several malignancies, but its utility in EC remains underexplored. To evaluate the prognostic significance of the preoperative NLR in patients with endometrial cancer undergoing primary surgical treatment. Methods: We conducted a retrospective cohort study including 398 patients with histologically confirmed endometrial adenocarcinoma surgically treated at a tertiary cancer center. Preoperative complete blood counts were used to calculate NLR, and a cutoff value of 2.27 was determined through Receiver Operating Characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards modeling. Patients with NLR ≥ 2.27 had significantly reduced median overall survival (OS) compared to those with NLR < 2.27 (72.3 vs. 92.8 months, = 0.008). In multivariate analysis, elevated NLR remained an independent predictor of poorer OS (HR = 1.87; 95% CI: 1.156-3.017; = 0.011), alongside age ≥ 64 years, lymphovascular space invasion (LVSI), lymph node involvement, and distant metastases. ROC analysis yielded an Area Under the Curve (AUC) of 0.646 for NLR. Notably, vaginal brachytherapy was associated with improved survival (HR = 0.53; = 0.026), while other adjuvant therapies were not independently significant. Preoperative NLR is an accessible, independent prognostic biomarker in endometrial cancer and may serve as a surrogate indicator of tumor-promoting inflammation and immune dysregulation. Its integration into preoperative assessment could enhance risk stratification and guide personalized treatment strategies. However, findings should be interpreted in light of the study's retrospective design, single-center setting, and lack of molecular classification data. Prospective validation is warranted to confirm its clinical utility.
子宫内膜癌（EC）是发达国家最常见的妇科恶性肿瘤。尽管在诊断和治疗方面取得了进展，但复发和死亡率仍然是重大问题。中性粒细胞与淋巴细胞比值（NLR）作为全身炎症的标志物，已在多种恶性肿瘤中显示出预后价值，但其在子宫内膜癌中的应用仍未得到充分探索。为了评估术前NLR对接受初次手术治疗的子宫内膜癌患者的预后意义。方法：我们进行了一项回顾性队列研究，纳入了在一家三级癌症中心接受手术治疗的398例经组织学确诊的子宫内膜腺癌患者。术前全血细胞计数用于计算NLR，并通过受试者操作特征（ROC）分析确定截断值为2.27。使用Kaplan-Meier分析和Cox比例风险模型评估生存结局。NLR≥2.27的患者与NLR<2.27的患者相比中位总生存期（OS）显著缩短（72.3个月对92.8个月，P = 0.008）。在多变量分析中，升高的NLR仍然是较差OS的独立预测因素（HR = 1.87；95%CI：1.156 - 3.017；P = 0.011），同时伴有年龄≥64岁、淋巴血管间隙浸润（LVSI）、淋巴结受累和远处转移。ROC分析得出NLR的曲线下面积（AUC）为0.646。值得注意的是，阴道近距离放疗与生存改善相关（HR = 0.53；P = 0.026），而其他辅助治疗并无独立显著意义。术前NLR是子宫内膜癌中一种可获取的独立预后生物标志物，可作为肿瘤促进性炎症和免疫失调的替代指标。将其纳入术前评估可加强风险分层并指导个性化治疗策略。然而，研究结果应结合该研究的回顾性设计、单中心设置以及缺乏分子分类数据来解读。有必要进行前瞻性验证以确认其临床效用。
