Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis

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/m 2 (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.

C-Reactive Protein as a Prognostic Biomarker for Gynecologic Cancers: A Meta-Analysis

“…Their basic characteristics are shown in Tables 1 and 2 . The patients were from various countries, including Austria [ 19 , 23 , 28 , 33 , 36 ], China [ 20 , 22 , 24 – 26 , 29 , 31 , 32 , 34 ], Poland [ 21 , 27 ], Japan [ 30 , 35 ], and the United Kingdom [ 37 ]. These studies were published between 2007 and 2021 and their sample sizes could be traced.…”

Impact of Type 2 Diabetes Mellitus on Endometrial Cancer Survival: A Prospective Database Analysis

“…The availability of data on socio-demographic and clinico-pathological characteristics allowed for a robust adjustment for confounding factors and effect modifications. To our knowledge, this is the first study to adjust for baseline CRP, a parameter that is known to be associated with T2DM status and which has been reported to independently predict outcomes in endometrial cancer ( 6 ). The established endometrial cancer prognostic factors, including FIGO stage, disease grade, histological subtype, LVSI and depth of myometrial invasion, were consistent in demonstrating the expected associations.…”

“…Identifying women with endometrial cancer who are at a higher risk of relapse and cancer-related mortality is fundamental to ensuring women receive appropriate evidence-based management whilst minimising the side effects and costs of unnecessary interventions for those at lowest risk ( 6 ). In current clinical practice, endometrial cancer risk assessment is based on clinico-pathological parameters including International Federation of Gynecology and Obstetrics (FIGO) surgical stage, tumour grade and histological subtype, lymphovascular space invasion and depth of myometrial invasion.…”

Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis

“…The consensus is therefore that laboratory parameters, including albumin derived indices, should be used alongside a thorough physical examination when assessing nutritional status [42]. Several immune-nutritional and inflammatory parameters have been suggested as potential endometrial cancer prognostic biomarkers, including the Naples prognostic score, controlling nutritional status (CONUT) score, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Glasgow prognostic score and C-reactive protein [43][44][45]. However, the evidence to enable their clinical translation is limited.…”