Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer

Abstract

Background: The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions. Methods: A total of 1111 patients with EC who had accepted surgical treatment during 2013-2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors. Results: The median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83-4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90-3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20-2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54-7.42, P<0.001), showed the highest prognostic value. The Harrell's concordance index of the nomogram was 0.847 (95% CI = 0.804-0.890), showing good discrimination and calibration of this model.

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

“…Recent studies indicate that NLR might be a useful diagnostic and prognostic marker for different cancers. 11,[32][33][34][35][36] A high NLR represents an increase in immunosuppressive status, and reportedly, is associated with poor survival in esophageal, gastric, colorectal, lung, breast cancer, and urologic cancers. 32,34 Regarding gynecologic malignancies, high NLR is associated with poor clinical outcomes in ovarian, endometrial, and cervical cancer, and in uterine sarcoma.…”

“…11,[32][33][34][35][36] A high NLR represents an increase in immunosuppressive status, and reportedly, is associated with poor survival in esophageal, gastric, colorectal, lung, breast cancer, and urologic cancers. 32,34 Regarding gynecologic malignancies, high NLR is associated with poor clinical outcomes in ovarian, endometrial, and cervical cancer, and in uterine sarcoma. 11,32,33,35 In a metaanalysis conducted by Wu et al in cervical cancer, an elevated NLR was found to be closely associated with poor clinical outcomes and unfavorable clinicopathological factors.…”

“…32,34 Regarding gynecologic malignancies, high NLR is associated with poor clinical outcomes in ovarian, endometrial, and cervical cancer, and in uterine sarcoma. 11,32,33,35 In a metaanalysis conducted by Wu et al in cervical cancer, an elevated NLR was found to be closely associated with poor clinical outcomes and unfavorable clinicopathological factors. 36 Similarly, Jeong et al reported that an elevated preoperative NLR (≥2.60) was associated with poor clinical outcomes in uterine sarcoma patients.…”

Role of Systemic Inflammatory Reaction in Female Genital Organ Malignancies – State of the Art

“…119 Kadan et al found that the mean NLR was higher in the node-positive group compared with node-negative patients (3.4 vs 2.9, respectively); however the difference was not statistically significant. 120 Cong 121 Eo et al analyzed 255 females with newly diagnosed endometrial cancer and reported an LMR cutoff value of 3.28 for both DFS and OS. 122 The 5-year DFS rates in the LMR-low and LMR-high groups were 64.5% and 93.9%, respectively (p<0.0001).…”

“…The combined indicator, high NLR + high PLR + high LMR (HR: 4.34, 95% CI: 2.54–7.42; p<0.001), showed the highest prognostic value. 121 Eo et al analyzed 255 females with newly diagnosed endometrial cancer and reported an LMR cutoff value of 3.28 for both DFS and OS. 122 The 5-year DFS rates in the LMR-low and LMR-high groups were 64.5% and 93.9%, respectively (p<0.0001).…”