Endometrioid Endometrium Kanserinde Lenfovasküler İnvazyon ve Lenf Nodu Metastazı İçin Sistemik İnflamatuvar ve Nutrisyonel İndekslerin Prognostik Değeri

Öz

Amaç: Bu çalışma, endometrioid tip endometrium kanserli hastalarda preoperatif dönemde değerlendirilen inflamatuvar parametreler olan nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR), monosit-lenfosit oranı (MLR), sistemik immün-inflamasyon indeksi (SII) ve C-reaktif protein (CRP) ile nutrisyonel göstergeler olan prognostik nutrisyonel indeks (PNI) ve albüminin, lenfovasküler invazyon (LVSI) ve lenf nodu metastazı (LNM) ile ilişkisini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Kasım 2023 ile Mayıs 2025 tarihleri arasında cerrahi uygulanan toplam 186 endometrioid endometrium kanserli hasta retrospektif olarak analiz edildi. Preoperatif kan parametreleri kullanılarak NLR, PLR, MLR, SII ve PNI hesaplandı. Hastalar LVSI ve LNM varlığına göre gruplandırıldı ve karşılaştırıldı. Her bir parametrenin ayırt edici gücünü değerlendirmek için alıcı işletim karakteristik (ROC) analizi yapıldı. Bulgular: LVSI saptanan 39 hastada PNI anlamlı derecede düşük, NLR, PLR, MLR, SII ve CRP ise anlamlı derecede yüksekti (tümü p<0,05). ROC analizinde, LVSI’yi öngörmede en yüksek AUC değeri NLR için bulundu (0,778). LNM saptanan 24 hastada NLR ve SII anlamlı derecede yüksek, lenfosit sayısı ise anlamlı derecede düşüktü (tümü p<0,05). PNI’nin LNM ile anlamlı bir ilişkisi bulunmadı. Sonuç: Preoperatif inflamatuvar indeksler, özellikle NLR ve SII, LVSI ve LNM riskinin öngörülmesinde klinik açıdan değerli biyobelirteçlerdir. PNI, LVSI pozitif hastalarda anlamlı derecede düşük bulunmasına rağmen ROC analizi prediktif performansının sınırlı olduğunu ortaya koymuştur. Bu nedenle PNI’nin, tek başına kullanıldığında zayıf kalan öngörü gücünün, diğer inflamatuvar indekslerle birlikte değerlendirildiğinde preoperatif risk sınıflamasına daha anlamlı katkı sağlayabileceği düşünülmektedir.

Anahtar Kelimeler

• Endometrioid Endometrium Kanseri
• Lenfovasküler Alan İnvazyonu
• Lenf Nodu Metastazı
• Nötrofil/Lenfosit Oranı
• Sistemik İmmün-İnflamasyon İndeksi
• Prognostik Nutrisyonel İndeks
• Preoperatif Biyobelirteçler

Prognostic Value of Systemic Inflammatory and Nutritional Indices for Lymphovascular Space Invasion and Lymph Node Metastasis in Endometrioid Endometrial Cancer

Abstract

Objective: This study aimed to evaluate the relationship between preoperative inflammatory parameters including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and C-reactive protein (CRP), as well as nutritional markers such as prognostic nutritional index (PNI) and albumin, with lymphovascular space invasion (LVSI) and lymph node metastasis (LNM) in patients with endometrioid endometrial cancer. Materials and Methods: A total of 186 patients with endometrioid endometrial cancer who underwent surgery between November 2023 and May 2025 were retrospectively analyzed. Preoperative blood parameters were used to calculate NLR, PLR, MLR, SII, and PNI. Patients were stratified according to the presence of LVSI and LNM, and compared accordingly. Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory ability of each parameter. Results: In 39 patients with LVSI, PNI was significantly lower, whereas NLR, PLR, MLR, SII, and CRP were significantly higher (all p<0.05). ROC analysis showed that NLR had the highest AUC for predicting LVSI (0.778), indicating moderate discrimination. Among 24 patients with LNM, NLR and SII were significantly higher, and lymphocyte count was significantly lower (all p<0.05). PNI showed no significant association with LNM. Conclusion: Preoperative inflammatory indices, particularly NLR and SII, appear to be valuable biomarkers for predicting the risk of LVSI and LNM. Although PNI was significantly lower in patients with LVSI, ROC analysis demonstrated limited predictive performance. Therefore, the prognostic utility of PNI may be more meaningful when assessed in conjunction with other inflammatory indices, contributing more effectively to preoperative risk stratification.

Keywords

• Endometrioid Endometrial Cancer
• Lymphovascular Space Invasion
• Lymph Node Metastasis
• Neutrophil-To-Lymphocyte Ratio
• Systemic Immune-Inflammation Index
• Prognostic Nutritional Index
• Preoperative Biomarkers

References

1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.
2. 2. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C; ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Ann Oncol 2016;27:16-41.
3. 3. Wang J, Xu P, Yang X, Yu Q, Xu X, Zou G, Zhang X. Association of myometrial invasion with lymphovascular space invasion, lymph node metastasis, recurrence, and overall survival in endometrial cancer: A meta-analysis of 79 studies with 68,870 patients. Front Oncol 2021;11:762329.
4. 4. Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Chu C, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Holmes J, Howitt BE, Lea J, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Aggarwal S. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023;21:181-209.
5. 5. Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol 2013;88:218-30.
6. 6. Matsubara S, Mabuchi S, Takeda Y, Kawahara N, Kobayashi H. Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer. PLoS One 2021;16:e0248871.
7. 7. Leng J, Wu F, Zhang L. Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, or monocyte-to-lymphocyte ratio in endometrial neoplasms: A systematic review and meta-analysis. Front Oncol 2022;12:734948.
8. 8. Kim YJ, Park HP, Kim HS, Park S. Preoperative prognostic nutritional index is a prognostic indicator of cancer-specific survival in patients undergoing endometrial cancer surgery. J Korean Med Sci 2023;38:e163.

9. 9. Cong R, Kong F, Ma J, Li Q, Wu Q, Ma X. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: A superior prognostic factor of endometrial cancer. BMC Cancer 2020;20:1-11.
10. 10. Lei H, Xu S, Mao X, Chen X, Chen Y, Sun X, Sun P. Systemic Immune-Inflammatory Index as a Predictor of Lymph Node Metastasis in Endometrial Cancer. J Inflamm Res 2021;14:7131-42.
11. 11. Zhou Q, Su S, You W, Wang T, Ren T, Zhu L. Systemic inflammation response index as a prognostic marker in cancer patients: A systematic review and meta-analysis of 38 cohorts. Dose Response 2021;19:15593258211064744.
12. 12. Bermúdez-Pineda B, García-Luna MÁ, Oñate-Ocaña LF, Morales-Piélago GF, Cantú-De León DF, Reynoso-Noverón N. Prognostic nutritional index as a predictor of surgical complications in women with gynecological cancer. Int J Gynecol Cancer 2025;6:ijgc-2024-005873.
13. 13. Ronsini C, Iavarone I, Della Corte L, Carotenuto R, Andreoli G, La Mantia E, De Franciscis P, Bifulco G, Cobellis L. Correlation between inflammatory index, endometrial thickness, and lymphovascular space invasion in endometrial cancer: A prospective observational study. Clin Exp Obstet Gynecol 2025;52:25917.
14. 14. Öztürk N, Ersak B, Öncü HN, Ege G, Yeşil B, Köksal OK, Hanedan C, Korkmaz V. Systemic inflammatory markers predict upstaging in early-stage endometrial cancer: A FIGO 2023 reclassification study. SN Compr Clin Med 2025;7:200.
15. 15. Njoku K, Barr CE, Ramchander NC, Crosbie EJ. Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis. PLoS One 2022;17:e0272232.
16. 16. Gulseren V, Daggez M, Sen E, Dolanbay M, Caglı F, Ozcelik B, Serin IS, Gungorduk K. The effect of prognostic nutritional index and systemic inflammatory index in endometrioid type endometrial cancer. Gynecol Obstet Reprod Med 2024;30:198-205.
17. 17. Gen Y, Yun J, Ahn J, Yoon JH, Park DC, Kim SI. Nutritional index in relation to prognosis of endometrial cancer. Int J Med Sci 2024;21:169-74.