Predictive Value of Hematological Inflammatory Markers in Endometrial Neoplasia

Document Type : Case series


Obstetrics and Gynaecology, İstanbul Training and Research Hospital, Turkey.


Objective: To investigate the predictive role of neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio
(PLR) as hematological inflammatory markers in cases of endometrial hyperplasia and cancer. Material and Method:
This retrospective study was performed between 2005-2015 with 247 cases of 83 endometrial adenocarcinoma (group
1), 64 of endometrial hyperplasia (group 2) and 100 controls (group 3) who underwent a curettage due to abnormal
uterine bleeding and had a normal histopathology in our tertiary clinic. The cases were chosen from patients without
chronic diseases, that do not have infection or medication that could affect the systemic inflammatory response. Preintervention
blood parameters were taken into account. The neutrophil/ lymphocyte and platelet/lymphocyte ratios were
and statistical comparisons of the groups were conducted. Results: The age distribution of 247 patients was between
26 and 85 years, and the mean age was 48.8 ± 8.92.The median age was 54 in group 1, 46 in group 2 and 45 in group 3.
The age was significant between group 1 and the other groups (p=0.001). Some 71% of the cases were premenopausal
and 29% were postmenopausal, the latter being significantly more frequent in group 1 (62.7%; p=0.001). Of the cases
with endometrial hyperplasia, 42 (65.6%) had simple and 22 (34.4%) have atypical-complex lesions. The median
NLRs in groups 1, 2, and 3 were 2.15, 2.10, and 1.92, respectively, with median PLRs of 135.1, 134.0 and 145.6.
There was a statistically significant difference between the NLR measurements of the cases from different groups
(p=0.048; p<0.05). The NLR value for the endometrial adenocarcinoma group was significantly higher than for the
control group (p=0.033; p<0.05). The optimum cut-off value was calculated to be ≥4, at which sensitivity was 20.5%,
specificity 99%, positive predictive value (PPV) 94.4% and negative predictive value (NPV) 60%. Conclusion: The
value of NLR ≥4 has predictive significance in distinguishing endometrial pathologies before intervention in patients
with abnormal uterine bleeding. Simple, cheap and easy-to-perform, the NLR can be used as a potential hematological
marker for endometrial malignancy.


Main Subjects