Abstract
BackgroundThe preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions.MethodsA total of 1111 patients with EC who had accepted surgical treatment during 2013–2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors.ResultsThe median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83–4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90–3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20–2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54–7.42, P<0.001), showed the highest prognostic value. The Harrell’s concordance index of the nomogram was 0.847 (95% CI = 0.804–0.890), showing good discrimination and calibration of this model.ConclusionThe combination of NLR, PLR, and MLR is a superior prognostic factor of EC. The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict OS for EC patients clinically.
Highlights
The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately
The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict overall survival (OS) for endometrial cancer (EC) patients clinically
The aim of the present study is to evaluate the prognostic value of preoperative peripheral blood NLR, PLR, and MLR and their combinations in patients with EC and provide a reliable scoring nomogram model for doctors to make standardized clinical decisions
Summary
The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions. Endometrial cancer (EC) is reported as the most common gynaecological tumour with increasing incidence in developed countries [1]. Effective prognostic indicators for early detection of probable recurrence may be helpful for timely and optimal treatment and improve the survival rate. In Kim’s [4] and Ding’s [5] studies, the combination of peripheral blood neutrophils and monocytes had higher prognostic value than CA-125
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