The inflammatory markers combined with CA125 may predict postoperative survival in endometrial cancer

Figures & data

Figure 1. Flow chart for inclusion/exclusion of EC patients.

Figure 2. ROC curves of the SII, NLR, MLR, PLR, PDW, and CA125 levels in predicting EC stage. ROC: receiver operating characteristic; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PDW: platelet distribution width; CA125: cancer antigen 125.

Table 1. Comparison of clinical indicators in early and advanced EC.

Parameter	I-II(n = 437)	III-IV(n = 51)	p
Age at surgery, median (Range), years	54(49–59)	54(51–61)	0.395
BMI, median (Range), kg/m^2	24.14(22.23–26.56)	24.57(22.36–26.70)	0.753
WBC, median (Range),10^9/L	6.13(5.02–7.15)	6.15(5.13–7.37)	0.498
ANC, median (Range),10^9/L	3.38(2.66–4.31)	3.64(2.85–4.93)	0.076
ALC, median (Range), 10^9/L	1.93(1.53–2.34)	1.72(1.45–2.12)	0.061
AMC, median (Range), 10^9/L	0.40(0.32–0.50)	0.43(0.34–0.52)	0.157
PLT, median (Range), 10^9/L	255(216–300)	274(215–330)	0.053
MPV, median (Range), fL	9.8(8.8–10.6)	9.5(8.7–10.2)	0.132
PCT, median (Range), %	0.25(0.20–0.29)	0.26(0.20–0.30)	0.291
PDW, median (Range), %	12.5(10.6–16.4)	11.5(9.8–15.0)	0.02
SII, median (Range)	440.94(309.17–685.22)	614.19(387.19–884.32)	0.001
NLR, median (Range)	1.74(1.33–2.32)	2.19(1.59–2.80)	0.001
MLR, median (Range)	0.20(0.16–0.26)	0.24(0.18–0.32)	0.002
PLR, median (Range)	131.98(99.56–172.96)	151.40(122.45–212.22)	0.002 <0.001
CA125, median (Range), U/ml	18.15(11.60–28.68)	37.70(17.9–121.50)
Menopause status, n (%)
Premenopausal	224	28	0.622
Postmenopausal	213	23
History of diabetes, n(%)
Yes	91	12	0.654
No	346	39

BMI: body mass index; WBC: white blood cell count; ANC: absolute neutrophil count; ALC: absolute lymphocyte count; AMC: absolute monocyte count; PLT: platelet count; MPV: mean platelet volume; PCT: platelet haematocrit; PDW: platelet distribution width; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; CA125: cancer antigen 125.

Table 2. Univariate and multivariate logistic regression analyses for EC stage.

Parameter	Univariable	p	Multivariable	p
	OR (95%CI)		OR (95%CI)
SII
≤574.87^R	2.806(1.673–4.706)	<0.001	0.900(0.377–2.147)	0.812
>574.87
NLR
≤1.98^R	2.613(1.494–4.568)	0.001	1.755(0.635–4.853)	0.278
>1.98
MLR
≤0.21^R	2.165(1.275–3.675)	0.004	1.057(0.544–2.053)	0.87
>0.21
PLR
≤112.77^R	3.237(1.611–6.504)	0.001	1.771(0.778–4.035)	0.174
>112.77
PDW
<10.0	2.622(1.455–4.725)	0.001	2.680(1.391–5.162)	0.003
≥10.0^R
CA125
≤28.35^R	4.557(2.662–7.800)	<0.001	3.828(2.162–6.777)	<0.001
>28.35

OR: odds ratio; CI: confidence interval; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PDW: platelet distribution width; CA125: cancer antigen 125; R: references group.

Table 3. Associations of PDW and CA125 level with clinical characteristics.

Parameters	PDW + CA125			p value
	0	1	2
Age (years)
≤55	164	94	17	0.97
>55	123	74	13
BMI (kg/m2)
≤25	117	77	13	0.703
>25	88	49	11
FIGO stage
I–II	266	141	14	<0.001
III–IV	21	27	16
Menopause status
Premenopausal	124	76	16	0.106
Postmenopausal	155	83	8
History of diabetes
Yes	63	33	4	0.752
No	216	126	20
History of hypertension
Yes	121	72	20	0.15
No	158	105	15

PDW: platelet distribution width; CA125: cancer antigen 125; BMI: body mass index; FIGO: International Federation of Gynaecology and Obstetrics. High PDW + low CA125 = 0 points; either low PDW or high CA125 = 1 point; both low PDW and high CA125 = 2 points.

Figure 3. Kaplan–Meier curve for OS of patients with EC stratified by PDW and CA125. (A) Kaplan-Meier curve for OS in EC patients in different PDW + CA125 groups (0 vs 1 vs 2). (B) Kaplan-Meier curve for OS in EC patients in different PDW + CA125 groups (0 and 1 vs 2).

PDW: platelet distribution width; CA125: cancer antigen 125. High PDW + low CA125 = 0 points; either low PDW or high CA125: 1 point; both low PDW and high CA125: 2 points.

Table 4. Univariate and multivariate Cox proportional hazards regression analyses for OS in EC.

Parameter	Univariable	p	Multivariable	p
	HR (95%CI)		HR (95%CI)
SII
≤574.87^R	3.575(1.322–9.668)	0.012	1.456(0.285–7.444)	0.652
>574.87
NLR
≤1.98^R	3.817(1.345–10.834)	0.012	2.681(0.486–14.795)	0.258
>1.98
MLR
≤0.21^R	2.637(0.929–7.486)	0.068	─	─
>0.21
PLR
≤112.77^R	0.985(0.364–2.664)	0.976	─	─
>112.77
PDW
<10.0	1.896(0.611–5.878)	0.268	─	─
≥10.0^R
CA125
≤28.35^R	1.966(0.700–5.525)	0.2	─	─
>28.35
PDW + CA125
0^R	─	─	─	─
1	1.074(0.314–3.668)	0.91	1.009(0.292–3.488)	0.989
2	7.580(1.958–29.340)	0.003	5.156(1.060–25.075)	0.042
FIGO stage
I-II^R	3.519(1.147–10.792)	0.028	1.401(0.321–6.117)	0.654
III-IV

PDW: platelet distribution width; CA125: cancer antigen 125; BMI: body mass index; FIGO: International Federation of Gynaecology and Obstetrics; HR: Hazard ratio; CI: confidence interval; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PDW: platelet distribution width; CA125: cancer antigen 125; FIGO: International Federation of Gynaecology and Obstetrics. High PDW + low CA125 = 0 points; either low PDW or high CA125 = 1 point; both low PDW and high CA125 = 2 points; R, references group.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.