The significance of preoperative leukocytosis in endometrial carcinoma

Worley, Michael J.; Nitschmann, Caroline C.; Shoni, Melina; Vitonis, Allison F.; Rauh‐Hain, J. Alejandro; Feltmate, Colleen M.

doi:10.1016/j.ygyno.2012.03.043

Cited by 23 publications

(19 citation statements)

References 16 publications

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“…Three studies lacked raw data, and because the authors did not respond after being contacted, these publications were excluded . Two studies had overlapping study cohorts, and one of these was excluded . One additional article was identified by extensive cross‐checking of the reference lists .…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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Background In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers. Aim To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer. Methods A systematic review was performed according to the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca‐125], lymphadenopathy on magnetic resonance imaging, computed tomography, and 18F‐fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET‐CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random‐effects meta‐analysis. Likelihood ratios were classified into small (0.5–1.0 or 1–2.0), moderate (0.2–0.5 or 2.0–5.0) or large (0.1–0.2 or ≥ 5.0) impact. Results Eighty‐three studies, comprising 18,205 patients, were included. Elevated Ca‐125 and thrombocytosis were associated with a moderate increase in risk of LNM; lymphadenopathy on imaging with a large increase. Normal Ca‐125, cytology, and no lymphadenopathy on 18FDG PET‐CT were associated with a moderate decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only small impact. Conclusion Ca‐125, thrombocytosis, and imaging had a large and moderate impact on risk of LNM and could improve preoperative risk stratification. Implications for Practice Routine lymphadenectomy in clinical early‐stage endometrial carcinoma does not improve outcome and is associated with 15%–20% surgery‐related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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“…Whether the elevated monocyte counts in endometrial cancer is secondary to a paraneoplastic syndrome via the tumor and bone marrow circuit remains unknown and warrants further study. Leukocytosis is known to be a prognostic factor for decreased survival in endometrial cancer patients [21,22,29]. The hypothesis behind this association includes tumor-related leukocytosis (TRL) driven by granulocyte colony-stimulating factor (GCSF) produced from the tumor [21].…”

Section: Discussionmentioning

confidence: 99%

Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer

Matsuo

Hom

Moeini

et al. 2015

Gynecologic Oncology

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“…Neutrophilia promotes development and progression of cancer by providing a suitable environment and secreting most circulating vascular endothelial growth factors 16. In a study by Worley et al in patients with leukocytosis in endometrial carcinoma, presentations accompanied by pathologic factors associated with poorer prognoses and with leukocytosis were independently associated with increased risk of death 17. Tavares-Murta et al showed that in patients with cervical cancer, those with advanced cancers had significantly higher frequency of leukocytes alterations than did those with preinvasive cancers, and that neutrophilia was the best indicator of cancer invasiveness 18…”

Section: Discussionmentioning

confidence: 99%

Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma

Wang¹,

Yang²,

Cao³

et al. 2013

OTT

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BackgroundThe purpose of this study was to evaluate the relationship between preoperative inflammatory markers (neutrophil-lymphocyte ratio and platelet-lymphocyte ratio) and cervical stromal involvement in patients with endometrioid adenocarcinoma.MethodsWe studied 318 patients with endometrioid adenocarcinoma who underwent comprehensive surgical staging. We used univariate and multivariate analyses of cervical stromal involvement and receiver-operating curves to calculate optimal cutoff values for neutrophil-lymphocyte and platelet-lymphocyte ratios to predict cervical stromal involvement.ResultsThe presence of cervical stromal involvement was associated with neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (P = 0.009 and P = 0.031, respectively). Multivariate analysis showed that higher neutrophil-lymphocyte and platelet-lymphocyte ratios independently predicted cervical stromal involvement (odds ratio 3.10, 95% confidence interval 1.10–8.76, P = 0.032, and odds ratio 5.27, 95% confidence interval 1.94–14.35, P = 0.001, respectively). At a threshold of 2.01, the neutrophil-lymphocyte ratio was 71.0% sensitive and 63.8% specific for stromal involvement; at a 172.24 threshold, the platelet-lymphocyte ratio was 48.4% sensitive and 88.9% specific.ConclusionPreoperative neutrophil-lymphocyte and platelet-lymphocyte ratios can help identify the risk of cervical stromal involvement in patients with endometrial cancer. Evaluating these ratios may help select patients who should be particularly watched and tested for cervical stromal involvement.

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The significance of preoperative leukocytosis in endometrial carcinoma

Cited by 23 publications

References 16 publications

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer

Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma

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