Preoperative Haematologic Markers for the Differentiation of Endometrial Cancer from Benign Endometrial Lesions in Postmenopausal Patients with Endometrial Masses

Figures & data

Table 1 Patient Characteristics of Malignant and Benign Lesions

	Malignant Lesions, Median (IQR) (n=84)	Benign Lesions, Median (IQR) (n=92)	P value
Age (years)	58.0 (51–74)	61.5 (51–86)	0.002
BMI (kg/m^2)	24.4 (18.4–32.5)	22.9 (15.7–34.4)	0.001
Nulliparity (n, %)	7 (8.3)	19 (20.7)	0.032
AUB (n, %)	66 (78.6)	27 (29.3)	0.000
Hypertension (n, %)	31 (36.9)	15 (16.3)	0.002
Diabetes mellitus (n, %)	12 (14.3)	7 (6.4)	0.024

Table 2 Laboratory Values Between Endometrial Malignancy and Benign Lesions

	Malignant Lesions, Median (IQR) (n=84)	Benign Lesions, Median (IQR) (n=92)	P-value
WBC (per µL)	6560.0 (3700–13,590)	5590.0 (3090–14,060)	0.000
ANC (per μL)	3969.7 (1997.9–12,434.8)	3182.3 (1192.7–8478.2)	0.000
MCV (fL)	89.8 (67.7–96.2)	91.7 (72.0–103.2)	0.000
MPV (fL)	9.95 (8.0–11.3)	10.20 (8.6–13.0)	0.000
PDW (fL)	10.95 (8.4–15.2)	11.70 (8.2–51.0)	0.015
CA125 (U/mL)	19.5 (5.2–290.8)	13.7 (4.5–71.4)	0.000
NLR	1.99 (0.81–17.94)	1.78 (0.03–4.02)	0.016
PMR	702.0 (214.5–2512.7)	632.0 (81.0–1370.8)	0.011
LMR	5.6 (0.85–11.97)	5.0 (0.65–408.47)	0.028
SII	514.1 (171.7–4449.7)	418.8 (8.6–1632.1)	0.009

Note: P-values for comparisons of medians were obtained using Wilcoxon rank-sum test.

Abbreviations: IQR, interquartile range; BMI, body mass index; WBC, white blood cell; ANC, absolute neutrophil count; MCV, mean corpuscular volume; MPV, mean platelet volume; PDW, platelet distribution width; NLR, neutrophil-lymphocyte ratio; PMR, platelet-to- monocyte ratio; LMR, lymphocyte-to-monocyte ratio; SII, systemic immune-inflammatory index.

Table 3 Univariate and Multivariate Analyses for the Discrimination of Variables That Predict Endometrial Adenocarcinoma

Optimal Cut-off		Univariate		Multivariate Adjusted for Age and BMI
		OR (95% CI)	P value	OR (95% CI)	P value
WBC (per µL)	≥6230	3.047 [1.648, 5.635]	0.000	3.131 [1.621, 6.049]	0.001
ANC (per μL)	≥2841	3.864 [1.933, 7.726]	0.000	3.958 [1.884, 8.313]	0.000
MCV (fL)	≤92.1	3.511 [1.810, 6.808]	0.000	3.103 [1.541, 6.248]	0.002
MPV (fL)	≤10.0	3.980 [2.080, 7.617]	0.000	4.048 [2.032, 8.064]	0.000
PDW (fL)	≤11.3	2.517 [1.371, 4.620]	0.003	3.079 [1.582, 5.990]	0.001
CA125 (U/mL)	≥13.5	3.706 [1.855, 7.404]	0.000	5.552 [2.533, 12.166]	0.000
NLR	≥1.96	2.390 [1.293, 4.415]	0.005	2.523 [1.305, 4.878]	0.006
PMR	≥883.3	2.778 [1.383, 5.583]	0.004	2.692 [1.272, 5.699]	0.010
LMR	≥6.85	2.639 [1.311, 5.313]	0.007	2.468 [1.184, 5.147]	0.016
SII	≥508.4	2.165 [1.178, 3.978]	0.013	2.336 [1.210, 4.096]	0.011

Notes: Results of multiple logistic regression with variables show a P-value less than 0.05 in univariate regression. Multivariate model is adjusted for BMI.

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; WBC, white blood cell; ANC, absolute neutrophil count; MCV, mean corpuscular volume; MPV, mean platelet volume; PDW, platelet distribution width; NLR, neutrophil-lymphocyte ratio; PMR, platelet-to- monocyte ratio; LMR, lymphocyte-to-monocyte ratio; SII, systemic immune-inflammatory index.

Table 4 Predictive Efficacy of Clinical Characteristics and Laboratory Data

	AUC	95% CI	Sensitivity	Specificity	LR+	LR-	PPV	NPV	P-value
BMI	0.641	0.559–0.723	0.571	0.685	1.813	0.626	0.623	0.636	0.001
WBC (per µL)	0.658	0.578–0.738	0.619	0.652	1.780	0.584	0.619	0.652	0.000
ANC (per μL)	0.666	0.586–0.745	0.821	0.457	1.511	0.391	0.580	0.737	0.000
MCV (fL)	0.661	0.581–0.742	0.786	0.489	1.538	0.438	0.584	0.714	0.000
MPV (fL)	0.659	0.579–0.740	0.762	0.554	1.710	0.430	0.610	0.718	0.000
PDW (fL)	0.606	0.522–0.690	0.607	0.620	1.596	0.634	0.593	0.633	0.014
CA125 (U/mL)	0.684	0.602–0.766	0.788	0.600	1.575	0.425	0.612	0.702	0.000
NLR	0.605	0.522–0.689	0.524	0.685	1.662	0.695	0.603	0.612	0.015
PMR	0.611	0.528–0.695	0.369	0.826	2.122	0.764	0.660	0.589	0.010
LMR	0.596	0.511–0.680	0.357	0.826	2.054	0.778	0.652	0.585	0.027
SII	0.615	0.532–0.698	0.524	0.663	1.555	0.718	0.587	0.604	0.007
Model 1	0.797	0.732–0.862	0.810	0.674	2.483	0.283	0.694	0.795	0.000

Note: Model 1= MPV+PDW+NLR.

Abbreviations: AUC, area under curve; CI, confidence interval; WBC, white blood cell; ANC, absolute neutrophil count; MCV, mean corpuscular volume; MPV, mean platelet volume; PDW, platelet distribution width; NLR, neutrophil-lymphocyte ratio; PMR, platelet-to- monocyte ratio; LMR, lymphocyte-to-monocyte ratio; SII, systemic immune-inflammatory index; LR+, Positive likelihood ratio; LR-, Negative likelihood ratio; PPV, positive predictive value; NPV, negative predictive value.

Figure 1 Receiver operating characteristic (ROC) curves for the differentiation between endometrial malignant and benign lesions. Model 1, a combination of hematologic markers (MPV+PDW+NLR).

Abbreviations: MPV, mean platelet volume; PDW, platelet distribution width; NLR, neutrophil-lymphocyte ratio.

Table 5 Summary of Recent Studies Using Hematologic Parameters as a Preoperative Diagnostic Marker

Author (Year)	WBC	ANC	Hb	MCV	RDW	PLT	MPV	PDW	NLR	LMR	PMR	PLR	SII	CA125
Acmaz et al (2014)^Citation18	◉					◉			◉			◉
Kurtoglu et al (2015)^Citation17							◉	◉
Karateke et al (2015)^Citation19							◉	◉
Kemal et al (2015)^Citation20					◉
Ural et al (2015)^Citation21								◉	◉
Abide et al (2018)^Citation22				◉	◉		◉
Pergialiotis et al (2018)^Citation23									◉
Bacanakgil et al (2018)^Citation24									◉
Zhang et al (2020)^Citation15			◉		◉		◉	◉						◉
Alper et al (2021)^Citation25									◉
Ilgen et al (2022)^Citation26									◉
Our study (2023)	◉	◉		◉			◉	◉	◉	◉	◉		◉	◉

Note: The colored parameters are a part that has been reported to be significant in common in several previous studies.

Abbreviations: WBC, white blood cell; ANC, absolute neutrophil count; Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width; MPV, mean platelet volume; PDW, platelet distribution width; NLR, neutrophil-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; PMR, platelet-to- monocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammatory index.

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