Sepúlveda-Rivera Cintia M, Rico-Mejía Pamela L, Pérez-Montiel Maria D, Cantú-de León David, Salcedo-Hernández Rosa A, Martínez-Alpizar Pamela, Duno-Caldera Sebastian, Barquet-Muñoz Salim A
Gynecologic Oncology, Instituto Nacional de Perinatología, Mexico City, MEX.
Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, MEX.
Cureus. 2025 Aug 12;17(8):e89855. doi: 10.7759/cureus.89855. eCollection 2025 Aug.
Nutritional and inflammatory prognostic indices derived from biochemical and hematological parameters are emerging as potential prognostic biomarkers in various malignancies, including endometrial cancer.
The objective of this study is to evaluate whether pre-treatment biomarkers of systemic inflammation are associated with survival outcomes in patients with endometrial cancer.
This retrospective cohort study included women treated for endometrial cancer at a single institution. Pre-treatment Onodera's Prognostic Nutritional Index (PNI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and Systemic Immune-Inflammation Index (SIII) were calculated, with cutoff values determined using receiver operating characteristic (ROC) curves and quartiles. Associations with overall survival (OS) were analyzed using Kaplan-Meier estimation and multivariable Cox proportional regression, adjusting for the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, grade, and adjuvant therapy. Odds ratios (ORs) were used due to the retrospective design.
We included 887 patients who underwent initial staging surgery between 1997 and 2019. The median age was 55.27 years, with a median follow-up of 59.63 months. High NLR (>2.8, OR 1.90, 95% confidence interval (CI): 1.26-2.87, p=0.002) and PLR (>103.2) and low LMR (<4.8, OR 2.09, 95% CI 1.39-3.15, p<0.001, area under the curve (AUC) 0.589, 95% CI 0.54-0.64) and PNI (<40.0) were associated with reduced five-year OS. The LMR demonstrated the highest, though modest, precision in AUC analysis and was significantly associated with OS and mortality risk. These indices may guide adjuvant therapy decisions in resource-limited settings.
Pre-treatment inflammatory indices, particularly LMR, are promising prognostic biomarkers for OS in endometrial cancer, offering accessible tools for risk stratification in low-middle-income settings. These indices should not replace established clinical prognosticators but may provide additive value. Prospective, multicenter studies are needed to confirm these findings and integrate them into clinical practice.
从生化和血液学参数得出的营养和炎症预后指标正成为包括子宫内膜癌在内的各种恶性肿瘤中潜在的预后生物标志物。
本研究的目的是评估全身炎症的治疗前生物标志物是否与子宫内膜癌患者的生存结果相关。
这项回顾性队列研究纳入了在单一机构接受子宫内膜癌治疗的女性。计算治疗前的小野寺预后营养指数（PNI）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）和全身免疫炎症指数（SIII），使用受试者工作特征（ROC）曲线和四分位数确定临界值。使用Kaplan-Meier估计和多变量Cox比例回归分析与总生存期（OS）的关联，并对国际妇产科联合会（FIGO）分期、组织学、分级和辅助治疗进行调整。由于是回顾性设计，使用了比值比（OR）。
我们纳入了1997年至2019年间接受初始分期手术的887例患者。中位年龄为55.27岁，中位随访时间为59.63个月。高NLR（>2.8，OR 1.90，95%置信区间（CI）：1.26 - 2.87，p = 0.002）、PLR（>103.2）以及低LMR（<4.8，OR 2.09，95% CI 1.39 - 3.15，p < 0.001，曲线下面积（AUC）0.589，95% CI 0.54 - 0.64）和PNI（<40.0）与五年总生存期降低相关。LMR在AUC分析中显示出最高（尽管适度）的准确性，并且与总生存期和死亡风险显著相关。这些指标可指导资源有限环境中的辅助治疗决策。
治疗前炎症指标，特别是LMR，是子宫内膜癌总生存期有前景的预后生物标志物，为中低收入环境中的风险分层提供了可及的工具。这些指标不应取代既定的临床预后指标，但可能提供附加价值。需要进行前瞻性、多中心研究来证实这些发现并将其纳入临床实践。
