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Ji P, He J. Prognostic value of pretreatment systemic immune-inflammation index in patients with endometrial cancer: a meta-analysis. Biomark Med 2024. [PMID: 38623927 DOI: 10.2217/bmm-2023-0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Background: The present work focused on evaluating the systemic immune-inflammation index (SII) for its role in predicting endometrial cancer (EC) patient prognosis by meta-analysis. Methods: SII's role in predicting the prognosis of EC patients was analyzed by calculating combined hazard ratios (HRs) and 95% CIs. Results: As revealed by combined analysis, an increased SII predicted poor overall survival (HR = 2.01; 95% CI = 1.58-2.57; p < 0.001) as well as inferior progression-free survival (HR = 1.87; 95% CI = 1.36-2.58; p < 0.001) of EC. Conclusion: An increased SII score significantly predicted poor overall survival and progression-free survival in subjects with EC. The SII is suitable for predicting short- and long-term prognoses of patients with EC.
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Affiliation(s)
- Pengtian Ji
- Department of Oncological Radiotherapy, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, 313000, China
| | - Junjun He
- Clinical Laboratory, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
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2
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Qin L. The predictive value of NLR, PLR and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. Discov Oncol 2024; 15:91. [PMID: 38555539 PMCID: PMC10982248 DOI: 10.1007/s12672-024-00956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To explore the application of neutrophils to lymphocytes ratio (NLR), platelet to lymphocyte ratio (PLR) and monocyte to lymphocyte ratio (MLR) in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. METHODS 80 patients with endometrial malignant tumor diagnosed in our hospital from January 2019 to December 2022 were selected as the study group, and 74 patients with benign uterine diseases confirmed by pathology in our hospital during the same period were randomly selected as the control group. The differences of NLR, PLR and MLR in the peripheral blood of patients in each group were compared, and the value of individual indicators in the diagnosis of endometrial malignant tumor was evaluated using the Receiver Operating Characteristic (ROC) curve. RESULTS In peripheral blood, the NLR, PLR and MLR value in patients with endometrial cancer (EC) were significantly higher than those in patients with benign uterine diseases (P < 0.05). The area under the curve (AUC) of NLR, PLR, MLR in peripheral blood were 0.777, 0. 675 and 0.698. The best cutoff values were 2.02, 132.06 and 0.166. The sensitivity and specificity were 62.5% and 79.7%, 62.5% and 63.5%, 81 3% and 47.3%. The combination of these three indicators can significantly improved the diagnostic efficiency in endometrial cancer (AUC = 0.780), and the sensitivity and specificity were 60% and 83.8%. CONCLUSIONS In peripheral blood, NLR, PLR and MLR have certain diagnostic value in the differential diagnosis of endometrial cancer. When NLR, PLR and MLR are elevated, we should be alert to the occurrence of endometrial malignant tumors, and the combined diagnostic efficiency is high.
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Affiliation(s)
- Lin Qin
- Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China.
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Jo J, Son M, Chae Y, Yun T, Koo Y, Lee D, Kang HG, Kang BT, Yang MP, Kim H. T-cell lymphoma infiltrating the uterus and ovaries of a Golden Retriever: a case report. Ir Vet J 2023; 76:23. [PMID: 37700381 PMCID: PMC10498590 DOI: 10.1186/s13620-023-00252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND To the best of our knowledge, this is the first report of female genital system infiltration of T-cell lymphoma in veterinary literature. CASE PRESENTATION A 1.5-year-old, intact female Golden Retriever was referred due to melena and hyporexia that lasted for three weeks. Fever (40.5℃), tachycardia, tachypnoea, pale mucous membranes, and purulent vaginal discharge were identified on physical examination. Blood analyses revealed leucocytosis, anaemia, hypoalbuminemia, and increased lactate and C-reactive protein levels. On abdominal radiography, the small intestine was moderately deviated because of an oval-shaped mass (13 cm × 8.7 cm) located in the mid-abdomen. An enlarged tubular-shaped structure that had the opacity of soft tissue located in dorsal to the bladder to the middle of the abdomen, and an oval-shaped mass (5.28 cm × 3.26 cm), which was suspected to be a medial iliac lymph node located at the sixth to seventh lumbar level. Abdominal ultrasonography revealed gas and fluid in the lumen of the uterine horn with a severely thickened wall, round enlarged lymph nodes around the genitourinary system, and free fluid in the abdominal cavity. Based on these results, pyometra was suspected, and an exploratory laparotomy was performed for ovariohysterectomy. The resected ovary and uterus were macroscopically hypertrophied. Histopathological examination of the ovary and uterus revealed neoplastic proliferation of large round cells with strong immunoreactivity for CD3, indicating T-cell lymphoma. Therefore, the young dog was diagnosed with genital lymphoma. CONCLUSIONS The present report describes T-cell lymphoma infiltrating the uterus and ovaries in a young dog, which is rarely diagnosed and could aid in the differential diagnosis of genital diseases in young dogs.
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Affiliation(s)
- Jaeyeop Jo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Mingyun Son
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
- College of Veterinary Medicine, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Hyun-Gu Kang
- Laboratory of Veterinary Obstetrics, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, 28644, Chungbuk, Republic of Korea.
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Kawahara N, Kawaguchi R, Waki K, Maehana T, Yamanaka S, Yamada Y, Kimura F. The prognosis predictive score around primary debulking surgery (PPSP) improves diagnostic efficacy in predicting the prognosis of ovarian cancer. Sci Rep 2022; 12:22636. [PMID: 36587139 PMCID: PMC9805439 DOI: 10.1038/s41598-022-27333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
In recent years, the pretreatment inflammatory responses have proven to predict the prognosis, but no report exists analyzing the combined inflammatory response of the pre- and postsurgical treatment. The current study aims to extract the factors predicting the recurrence and create novel predictive scoring. This retrospective study was conducted at our institution between November 2006 and December 2020, with follow-up until September 2022. Demographic and clinicopathological data were collected from women who underwent primary debulking surgery. We created the scoring system named the prognosis predictive score around primary debulking surgery(PPSP) for progression-free survival(PFS). Univariate and multivariate analyses were performed to assess its efficacy in predicting PFS and overall survival(OS). Cox regression analyses were used to assess its time-dependent efficacy. Kaplan-Meier and the log-rank test were used to compare the survival rate. A total of 235 patients were included in the current study. The cut-off value of the scoring system was six. Multivariate analyses revealed that an advanced International Federation of Gynecology and Obstetrics(FIGO) stage (p < 0.001 for PFS; p = 0.038 for OS), the decreased white blood cell count difference (p = 0.026 for PFS) and the high-PPSP (p = 0.004 for PFS; p = 0.002 for OS) were the independent prognostic factors. Cox regression analysis also supported the above results. The PPSP showed good prognostic efficacy not only in predicting the PFS but also OS of ovarian cancer patients comparable to FIGO staging.
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Affiliation(s)
- Naoki Kawahara
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Ryuji Kawaguchi
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Keita Waki
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Tomoka Maehana
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Shoichiro Yamanaka
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Yuki Yamada
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
| | - Fuminori Kimura
- grid.410814.80000 0004 0372 782XDepartment of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan
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The Association between Diabetes Mellitus, High Monocyte/Lymphocyte Ratio, and Survival in Endometrial Cancer: A Retrospective Cohort Study. Diagnostics (Basel) 2022; 13:diagnostics13010044. [PMID: 36611336 PMCID: PMC9818819 DOI: 10.3390/diagnostics13010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
This retrospective cohort study aimed to evaluate the factors related to endometrial cancer (EC) prognosis and survival in eastern Taiwan. The study involved 48 patients diagnosed with EC who underwent hysterectomy-based surgery at Hualien Tzu Chi hospital between January 2011 and June 2021. The patients’ medical history and laboratory examination results were reviewed. Progression-free survival and overall survival were determined. Categorical variables were analyzed using the chi-square test, and continuous variables were analyzed using the independent t-test. The receiver operating characteristic curve was used to predict diagnostic value. Factors associated with cancer mortality were identified via Cox regression analysis (p < 0.05). Patients were divided into the death (n = 7) and survival (n = 41) groups. The median age of the patients was 56 years (range: 31−71 years). The median observation period was 33.29 months. Diabetes mellitus (DM) and monocyte/lymphocyte ratio (MLR) > 0.23886 were significantly associated with cancer mortality (p = 0.024 and p = 0.028, respectively). MLR-low and MLR-high groups exhibited 5-year overall survival rates of 96% and 60%, respectively, and 5-year progression-free survival rates of 96% and 41%, respectively. DM and MLR of >0.2386 were suggested to be associated with cancer death, poor overall survival, and progression-free survival.
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Winarto H, Habiburrahman M, Anggraeni TD, Nuryanto KH, Julianti RA, Purwoto G, Andrijono A. The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models. J Clin Med 2022; 12:jcm12010096. [PMID: 36614896 PMCID: PMC9821387 DOI: 10.3390/jcm12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Given the role of inflammation in carcinogenesis, this study investigated the utility of pre-treatment inflammatory markers as associative indicators for advanced-stage disease, lymph node metastasis (LNM), and distant metastasis (DM) in vulvar cancer (VC). METHODS A cross-sectional study was conducted on 86 women with VC in a single centre in Jakarta, Indonesia. The laboratory data was based on C-reactive protein (CRP), procalcitonin, the erythrocyte sedimentation rate (ESR) and fourteen derived, recorded and calculated ratios: leukocyte-to-platelet (LPR), neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), neutrophil-to-monocyte (NMR), platelet-to-monocyte (PLR), lymphocyte-to-monocyte (LMR), basophil-to-monocyte (BLR), systemic immune-inflammation index (SII), body mass index, albumin, and NLR (BAN) score, haemoglobin-to-platelet (HPR), prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), CRP-to-albumin, and CRP-to-procalcitonin. The optimal cut-off for each marker was determined using receiver operating characteristic (ROC) curve analysis, and their diagnostic indicator performances were assessed. The utility of these ratios as associative factors for three endpoints was further evaluated in multivariate regression models. RESULTS Investigated inflammatory markers exhibited specific performances for individual adverse outcomes, proving a fair to excellent ability in case finding and screening. After adjustment, the BAN score ≤ 334.89 (OR 9.20, p = 0.001) and ESR ≥ 104 (OR 4.18, p = 0.048) become two advanced-stage associative factors with AUC: 0.769. LNM was solely determined by higher NLR ≥ 2.83 (OR 4.15, p = 0.014) with AUC: 0.615. Meanwhile, BLR ≥ 0.035 (OR 5.67, p = 0.001) and ESR ≥ 84 (OR 6.01, p = 0.003) were contributing factors for DM, with AUC: 0.765. CONCLUSIONS Inflammatory markers are crucial for identifying the deleterious outcomes of VC. Accordingly, yielded models require external validation.
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Affiliation(s)
- Hariyono Winarto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Muhammad Habiburrahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Tricia Dewi Anggraeni
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Kartiwa Hadi Nuryanto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Renny Anggia Julianti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Gatot Purwoto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Andrijono Andrijono
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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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. [PMID: 35651788 PMCID: PMC9149577 DOI: 10.3389/fonc.2022.734948] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/31/2022] [Indexed: 01/28/2023] Open
Abstract
Aim Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), or monocyte–lymphocyte ratio (MLR) has been shown to be related to the poor prognosis of cervical cancer, ovarian cancer, breast cancer, and other malignant tumors, but their role in predicting the prognosis of endometrial cancer is still controversial. Therefore, we conducted this meta-analysis to evaluate the effectiveness of NLR more accurately, PLR, or MLR in predicting the prognosis of endometrial cancer (EC). Methods This review systematically searched for relevant publications in databases of the Cochrane Library, PubMed, EMBASE, CNKI, WanFang, VIP, and CBM. Pooled hazard ratios (HR) with 95% confidence intervals (95% CI) were determined and used to explore the association between inflammatory biomarkers (NLR, PLR, and MLR) and overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) in a random-effects model. We also conducted subgroup analysis and publication bias in this meta-analysis. Stata 12.0 was used for statistical analysis. Results This meta-analysis contained 14 eligible studies including 5,274 patients. Our results showed that NLR or PLR was associated with OS [NLR: HR, 2.51; 95% CI, 1.70–3.71; p <0.001 in univariate analysis (Ua); HR, 1.87; 95% CI, 1.34–2.60; p <0.001 in multivariate analysis (Ma); PLR: HR, 2.50; 95% CI, 1.82–3.43; p <0.001 in Ua; HR, 1.86; 95% CI, 1.22–2.83; p = 0.004 in Ma], but MLR was not associated with OS (HR, 1.44; 95% CI, 0.70–2.95; p = 0.325 in Ua; HR, 1.01; 95% CI, 0.39–2.60; p =0.987 in Ma). A further subgroup analysis found that the correlations were not affected by race, cutoff value, sample size, or treatment. Our meta-analysis showed that NLR or PLR was associated with DFS (NLR: HR, 2.50; 95% CI, 1.38–4.56; p =0.003 in Ua; HR, 2.06; 95% CI, 1.26–3.37, P =0.004 in Ma; PLR: HR, 1.91; 95% CI, 1.30–2.81; p = 0.001 in Ua), and NLR was associated with PFS only in the univariate analysis (HR, 1.71; 95% CI, 1.04–2.81; p =0.035 in Ua; HR, 1.79; 95% CI, 0.65–4.89; P =0.257 in Ma), but MLR was not associated with DFS (HR, 0.36; 95% CI, 0.03–4.13; p =0.409 in Ua). Conclusions Our results indicated that pretreatment NLR and PLR were biomarkers of poor prognosis in patients with endometrial cancer. The results indicated that NLR or PLR was associated with OS and disease-free survival DFS, and NLR was associated with PFS only in univariate analysis, but MLR was not associated with OS or DFS.
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Affiliation(s)
- Jiali Leng
- Division of Obstetrics and Gynecology, The Second Hospital of Jilin University, Jilin University, Changchun, China
| | - Fei Wu
- Division of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Lihui Zhang
- Division of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
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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 2022; 14:7131-7142. [PMID: 34992410 PMCID: PMC8710076 DOI: 10.2147/jir.s345790] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose This study assessed the predictive value of the preoperative systemic immune-inflammatory index (SII) for lymph node metastasis (LNM) in endometrial cancer (EC) patients. Methods We retrospectively included 392 EC patients between January 2013 and January 2019. Data on clinical indicators including age, body mass index (BMI), menopause, serum inflammatory immune index, serum tumor markers, history of diabetes and hypertension, stage, histological type, and myometrial invasion (MI) were collected. The association between clinical indicators and LNM was evaluated. Results The results indicated that neutrophil (NE), monocyte (MO) counts, SII, cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 199 (CA199), and the expression of estrogen receptor (ER) and Ki67 were higher in EC patients with LNM than in those without LNM (P<0.05). Lymph vascular space invasion (LVSI) was also associated with LNM (P<0.05). Consequently, the SII, CA125, CA153 and LVSI were found to be independent risk factors for LNM, and a nomogram including these indicators was performed. The ROC curve analysis showed that compared with a single index, the combination of the SII, CA125, CA153 and LVSI significantly improved the efficiency of diagnosing LNM in EC patients (AUC=0.865, P < 0.001). Moreover, the SII was significantly associated with age, menopause, and FIGO stage (P < 0.05). Further logistic regression analysis suggested that elevated serum SII was an independent risk factor for MI and progression to a higher pathological grade in young premenopausal EC patients. In addition, elevated SII was an independent risk factor for advanced EC progression in age ≥55 or postmenopausal EC patients. Conclusion An elevated SII is an independent risk factor for LNM in patients with EC. In addition, the SII can be used as a predictor of MI and higher pathological grade in young premenopausal EC patients.
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Affiliation(s)
- HuiFang Lei
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - ShuXia Xu
- Department of Pathology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - XiaoDan Mao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - XiaoYing Chen
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - YaoJia Chen
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - XiaoQi Sun
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - PengMing Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Bilir F, Arioz DT, Vatansever N, Filiz T, Elaziz B. Hematologic parameters as a predictor of myometrial and cervical invasion in endometrial cancer. Minerva Obstet Gynecol 2021; 73:770-775. [PMID: 34905880 DOI: 10.23736/s2724-606x.21.04715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite significant improvements in molecular biology for uterine cancer, we did not have specific peripheral blood biomarkers for clinical usage such as prognostic or predictive outcomes of disease in the last decade. METHODS A retrospective endometrial cancer database was collected from a tertiary gynecologic cancer center. The cohort included only endometrioid type uterine cancer. Subsequently, we investigated the relationship between preoperative hematologic parameters and pathologic findings. RESULTS In this study, 191 non-metastatic endometrial cancer (median age was 61 years, ranging from 41 to 86 years) were analyzed. Lymphocyte-to-monocyte ratio (LMR) was significantly different between the FIGO stage I and II (4.48 vs. 3.88, P=0.004). Platelet-to-lymphocyte (PLR) was significantly higher in FIGO stage III than stage I, and LMR was significantly decreased by each FIGO stage. LMR values significantly decreased with a depth of myometrial invasion. PLR and eosinophil-to-lymphocyte ratio (ELR) values were significantly higher in patients with cervical invasion compared to those without invasion, 287 vs. 144, P=0.005, 10.3 vs. 6, P=0.022, respectively. CONCLUSIONS This study revealed that low-LMR levels and high-PLR with ELR levels correlated with myometrial and cervical invasion, respectively. These findings can explain why hematologic parameters have an impact on oncologic outcomes.
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Affiliation(s)
- Filiz Bilir
- Department of Gynecologic Oncology, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey -
| | - Dağıstan T Arioz
- Department of Gynecologic Oncology, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
| | - Nefize Vatansever
- Department of Gynecologic Oncology, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
| | - Tarık Filiz
- Department of Gynecologic Oncology, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
| | - Burçin Elaziz
- Department of Gynecologic Oncology, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
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Njoku K, Ramchander NC, Wan YL, Barr CE, Crosbie EJ. Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis. Gynecol Oncol 2021; 164:146-153. [PMID: 34802721 PMCID: PMC8802781 DOI: 10.1016/j.ygyno.2021.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Inflammation predisposes to tumorigenesis by damaging DNA, stimulating angiogenesis and potentiating pro-proliferative and anti-apoptotic processes. The aim of this study was to investigate whether pre-treatment biomarkers of systemic inflammation are associated with survival outcomes in endometrial cancer. PATIENTS AND METHODS Women with endometrial cancer were recruited to a prospective database study. Pre-treatment systemic markers of inflammation, including C-reactive protein (CRP), Glasgow Prognostic Score and lymphocyte-based ratios [neutrophil-lymphocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII)], were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox regression. RESULTS In total, 522 women of mostly White British ethnicity, with a median age of 66 years (interquartile range (IQR), 56, 73) and BMI of 32 kg/m2 (IQR 26, 39) were included in the analysis. Most had low-grade (67.2%), early-stage (85.4% stage I/II), endometrioid (74.5%) tumors. Women with pre-treatment CRP ≥5.5 mg/L had a 68% increase in overall (adjusted HR = 1.68, 95% CI 1.00-2.81, p = 0.049) and a two-fold higher cancer-specific mortality risk than those with CRP <5.5 mg/L (adjusted HR = 2.04, 95%CI 1.03-4.02, p = 0.04). Absolute lymphocyte count, NLR, MLR and SII were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. CONCLUSION If confirmed in an independent cohort, CRP may offer a simple, low-cost test to refine pre-treatment risk assessment and guide personalised care in endometrial cancer. Our participants were mostly of White British ethnicity and further studies are needed to confirm the utility of CRP as a prognostic biomarker in other populations.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom; Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Neal C Ramchander
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Y Louise Wan
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Chloe E Barr
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom; Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
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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. [PMID: 33989285 PMCID: PMC8121307 DOI: 10.1371/journal.pone.0248871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The systemic immune-inflammation index (SII), which is calculated using absolute platelet, neutrophil, and lymphocyte counts, has recently attracted attentions as a prognostic indicator in patients with solid malignancies. In the current study, we retrospectively investigated the prognostic significance of pre-treatment SII among patients with endometrial cancer. METHOD Endometrial cancer patients treated at Nara medical university hospital between 2008 and 2018 were included in the current study. Receiver operating characteristic (ROC) curve was used to find the optimal SII cut-off values for 3-years progression free survival (PFS) and overall survival (OS). Then, the predictive abilities of SII and its superiority over neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were investigated. Kaplan-Meier method was used to calculate the OS and PFS rates, and log-rank test was used to compare the survival rate between two groups. Univariate and multivariate Cox regression analysis were performed to identify risk factors for PFS and OS. RESULT A total of 442 patients were included in the current study. The cut-off value of SII for predicting PFS and OS were defined by ROC analysis as 931 and 910, respectively. Univariate analyses showed that elevated SII was associated with significantly shorter survival (p <0.001 for both PFS and OS). Cox regression analyses revealed that an advanced FIGO stage (p <0.001 for both PFS and OS) and an elevated SII (p = 0.014 for PFS, p = 0.011 for OS) are the independent prognostic factors for survival. When SII was compared with NLR and PLR, SII showed greater area under curve for predicting survival. CONCLUSION The SII is an independent prognostic factor in endometrial cancer patients, allowing more precise survival estimation than PLR or NLR.
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Affiliation(s)
- Sho Matsubara
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
| | - Seiji Mabuchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
- * E-mail:
| | - Yoshinori Takeda
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
| | - Naoki Kawahara
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
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Koukourakis MI, Giatromanolaki A. Lymphopenia and intratumoral lymphocytic balance in the era of cancer immuno-radiotherapy. Crit Rev Oncol Hematol 2021; 159:103226. [PMID: 33482348 DOI: 10.1016/j.critrevonc.2021.103226] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/15/2020] [Accepted: 01/16/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The immune response has been recognized as a major tumor-eradication component of radiotherapy. OBJECTIVE This review studies, under a clinical perspective, two contrasting effects of radiotherapy, namely immunosuppression and radiovaccination. MATERIALS AND METHODS We critically reviewed the available clinical and experimental experience on radiotherapy-induced lymphopenia. RESULTS Radiation-induced tumor damage promotes radio-vaccination, enhances cytotoxic immune responses, and potentiates immunotherapy. Nevertheless, radiotherapy induces systemic and intratumoral lymphopenia. The above effects are directly related to radiotherapy fractionation and field size/location, and tumor characteristics. DISCUSSION Hypofractionated stereotactic and accelerated irradiation better promotes radio-vaccination and produces less severe lymphopenia. Adopting cytoprotective policies and combining lympho-stimulatory agents or agents blocking regulatory lymphocyte activity are awaited to unmask the radio-vaccination effect, enhancing the efficacy immuno-radiotherapy. CONCLUSION Radiation-induced lymphopenia and immunosuppression are important issues that should be considered in the design of immuno-radiotherapy clinical trials.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece.
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
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