Can preoperative inflammatory markers differentiate endometrial cancer from complex atypical hyperplasia/endometrial intraepithelial neoplasia?

Abstract

Aim: The aim of this study was to identify the differences between complex atypical hyperplasia/ endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid-type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer. Methods: Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid-type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut-off values found in the ROC analysis. Results: The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut-off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively. Conclusions: The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions.

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

“…Pro-inflammatory cytokines (eg, IL1β, IL6, and IL8) may be predictive markers of the incidence and stage of cancer, as well as prognostic markers of DFS and OS. 115 Research on the use of anti-inflammatory drugs after surgery has been initiated to investigate the SIR-to-healing process following tumor resection. It has been shown that the use of such agents can improve treatment outcomes in patients with cancer and reduce the risk of disease recurrence after breast cancer surgery.…”

“… 114 Subsequently, Selen et al confirmed in a multivariate analysis that low PLR (≤133.3) was related to a statistically significant OR (8.01; p<0.001) for the diagnostic prediction of low-grade endometrioid endometrial cancer compared with endometrial intraepithelial neoplasia. 115 Acmaz et al investigated the diagnostic utility of elevated NLR and PLR in females experiencing abnormal bleeding. 116 Although the NLR was significantly higher in patients with cancer than in those with endometrial atypia and controls (p=0.001 and p=0.025, respectively), there was no difference between patients with simple endometrial hyperplasia and controls.…”

“…Pro-inflammatory cytokines (eg, IL1β, IL6, and IL8) may be predictive markers of the incidence and stage of cancer, as well as prognostic markers of DFS and OS. 115 …”

The state of local markers of inflammation and apoptosis in endometry in hyperplasia of various degrees of severity

“…В клинической практике наряду с традиционным подходом все большую распространенность получает применение классификации ВОЗ [1,2]. Идея разделения двух событий, эстрогенной стимуляции и мутационной активации, не только позволяет исследовать оба компонента по отдельности, но и дает более понятную модель многоэтапного канцерогенного процесса [1,3]. В качестве потенциальных биомаркеров для определения ГЭ, находящихся в зоне риска злокачественного перерождения, рассматриваются разнообразные иммуногистохимические и молекулярные факторы.…”

“…), гиперплазия эндометрия (ГЭ) делится на две группы: гиперплазия без атипии и гиперплазия с атипией (АГЭ)/эндометриальная интраэпителиальная неоплазия (ЭИН). Частота малигнизации для ГЭ без атипии составляет 1-3 %, в то время как для пациентов с АГЭ/ЭИН -30 % и более [2,3]. Такая тесная взаимосвязь и неуклонный рост встречаемости ГЭ и рака эндометрия, который является наиболее распространенным гинекологическим злокачественным новообразованием женщин в развитых странах в основном из-за старения населения и развития нарушений метаболизма, диктуют необходимость поиска эффективных диагностических и прогностических маркеров [4,5].…”