Fragmented QRS and Neutrophil-to-Lymphocyte Ratio as Noninvasive Biomarkers of Lymphovascular Space Invasion in Endometrial Cancer: A Retrospective Cohort Study

Abstract

Objective To evaluate the prognostic significance of fragmented QRS (fQRS) on electrocardiography and the neutro- phil-to-lymphocyte ratio (NLR) as noninvasive bio- markers in endometrial cancer, with particular focus on their association with lymphovascular space inva- sion (LVSI). Material and Method In this retrospective cohort study, 198 patients who underwent surgery for endometrial cancer were in- cluded. All cases were staged according to the 2023 FIGO classification. Preoperative complete blood counts and electrocardiograms were assessed to de- termine NLR and the presence of fQRS. Clinicopath- ological variables, including LVSI status, were record- ed and statistically analyzed. Results The median NLR was significantly higher in patients with fragmented QRS compared with those with- out fragmented QRS (2.45 [1.46–12.42] vs. 2.04 [0.66–7.72], p = 0.013). LVSI positivity was observed more frequently among patients with fQRS (30% vs. 11.3%, p = 0.007). ROC curve analysis identified an optimal NLR cut-off value of 2.4 for predicting substan- tial LVSI (AUC = 0.62, 95 % CI: 0.55–0.69, p = 0.013), with a sensitivity of 64.3% and specificity of 58.2%. Multivariable logistic regression analysis demonstrat- ed that higher BMI (OR: 1.07, 95% CI: 1.01–1.14, p = 0.031), smoking (OR: 2.84, 95% CI: 1.18–6.84, p = 0.020), hypertension (OR: 0.38, 95% CI: 0.15–0.96, p = 0.041), and LVSI positivity (OR: 3.21, 95% CI: 1.24– 8.31, p = 0.016) were independently associated with the presence of fragmented QRS. Conclusion Both fQRS and NLR were associated with LVSI in pa- tients with endometrial cancer and may reflect adverse pathological features related to tumor aggressiveness. However, these findings should be considered explor- atory, and further prospective studies are required be- fore clinical implementation can be recommended.

Keywords

• Endometrial cancer
• Fragmented QRS
• Lymphovascular space invasion
• Neutrophil-to-lymphocyte ratio
• Prognostic biomarker

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical Statement

Ethical approval was obtained from the Institutional Ethics Committee (AESH-BADEK2) with the approval number 2025-414. The study was conducted in accordance with the principles of the Declaration of Helsinki. Due to the retrospective design of the study, the requirement for informed consent was waived by the ethics committee.

Thanks

The authors would like to thank all healthcare professionals involved in the management of the patients included in this study.

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