Chronic inflammation is one of the possible biological mechanisms underlying endometrial carcinogenesis. The aim of this study was to investigate whether pre-treatment biomarkers of systemic inflammation were associated with clinical outcomes in endometrial cancer (EC).
A total of 114 EC patients were analyzed in this multicenter retrospective study. All patients included in the study underwent chemotherapy. Blood count values were collected before the start of treatment. The correlation between platelet count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune inflammation index (SII - calculated as (platelet count × neutrophil count)/lymphocyte count), and progression-free survival (PFS) and overall survival (OS) were analyzed using the Cox regression model.
Endometrioid histology (70.2%), high grade (64.3%) and good (0) ECOG performance status (PS) (77%) were present in the majority of patients. Approximately half of the patients (51.8%) received adjuvant radiotherapy, 20.2% were metastatic and 26.8% were obese. Patients with high NLR (≥3), PLR (≥169), SII (≥730) and platelet count (>400 thousands) had significantly shorter PFS and OS. In multivariate analysis adjusted for age, histology, grade, stage, adjuvant radiotherapy, body mass index and PS, NLR, PLR, SII and platelet count were predictive for PFS. All inflammatory indexes except SII were also significantly associated with OS (table).
| PFS | OS | |||
| INFLAMMATORY INDEX | HR (95% CI) | p | HR (95% CI) | p |
| NLR | ||||
| <3 | 1.00 | 1.00 | ||
| >=3 | 3.40 (1.74-6.66) | 0.0004 | 3.05 (1.40-6.65) | 0.005 |
| PLR | ||||
| <169 | 1.00 | 1.00 | ||
| >=169 | 3.70 (1.83-7.49) | 0.0003 | 7.36 (2.89-18.76) | <0.0001 |
| SII | ||||
| <730 | 1.00 | 1.00 | ||
| >=730 | 2.63 | 0.016 | 2.36 | 0.062 |
| Platelets count | ||||
| <=400 | 1.00 | 1.00 | ||
| >400 | 4.53 (1.70-12.09) | 0.003 | 11.18 (3.79-32.99) | <0.0001 |
NLR, PLR and platelet count were independent predictors of PFS and OS in patients with EC treated with chemotherapy. High SII was associated with worse PFS but not OS.