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Published in: Discover Oncology 1/2024

Open Access 01-12-2024 | Endometrial Cancer | Research

The predictive value of NLR, PLR and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors

Author: Lin Qin

Published in: Discover Oncology | Issue 1/2024

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Abstract

Objective

To explore the application of neutrophils to lymphocytes ratio (NLR), platelet to lymphocyte ratio (PLR) and monocyte to lymphocyte ratio (MLR) in the differential diagnosis of benign uterine diseases and endometrial malignant tumors.

Methods

80 patients with endometrial malignant tumor diagnosed in our hospital from January 2019 to December 2022 were selected as the study group, and 74 patients with benign uterine diseases confirmed by pathology in our hospital during the same period were randomly selected as the control group. The differences of NLR, PLR and MLR in the peripheral blood of patients in each group were compared, and the value of individual indicators in the diagnosis of endometrial malignant tumor was evaluated using the Receiver Operating Characteristic (ROC) curve.

Results

In peripheral blood, the NLR, PLR and MLR value in patients with endometrial cancer (EC) were significantly higher than those in patients with benign uterine diseases (P < 0.05). The area under the curve (AUC) of NLR, PLR, MLR in peripheral blood were 0.777, 0. 675 and 0.698. The best cutoff values were 2.02, 132.06 and 0.166. The sensitivity and specificity were 62.5% and 79.7%, 62.5% and 63.5%, 81 3% and 47.3%. The combination of these three indicators can significantly improved the diagnostic efficiency in endometrial cancer (AUC = 0.780), and the sensitivity and specificity were 60% and 83.8%.

Conclusions

In peripheral blood, NLR, PLR and MLR have certain diagnostic value in the differential diagnosis of endometrial cancer. When NLR, PLR and MLR are elevated, we should be alert to the occurrence of endometrial malignant tumors, and the combined diagnostic efficiency is high.
Literature
1.
2.
3.
go back to reference Tavares-Murta BM, Mendonça MA, Duarte NL, et al. Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer. 2010;20(7):1154–9.CrossRefPubMed Tavares-Murta BM, Mendonça MA, Duarte NL, et al. Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer. 2010;20(7):1154–9.CrossRefPubMed
4.
go back to reference Stojkovic LM, Pavlovic MA, Stankovic S, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers. 2019;2019:6036979.PubMedPubMedCentral Stojkovic LM, Pavlovic MA, Stankovic S, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers. 2019;2019:6036979.PubMedPubMedCentral
5.
go back to reference Altan M, Haberal HB, Akdoğan B, et al. A critical prognostic analysis of neutrophil-lymphocyte ratio for patients undergoing nephroureterectomy due to upper urinary tract urothelial carcinoma. Int J Clin Oncol. 2017;22(5):964–71.CrossRefPubMed Altan M, Haberal HB, Akdoğan B, et al. A critical prognostic analysis of neutrophil-lymphocyte ratio for patients undergoing nephroureterectomy due to upper urinary tract urothelial carcinoma. Int J Clin Oncol. 2017;22(5):964–71.CrossRefPubMed
6.
go back to reference Miyatani K, Saito H, Kono Y, et al. Combined analysis of the pre- and postoperative neutrophil-lymphocyte ratio predicts the outcomes of patients with gastric cancer. Surg Today. 2018;48(3):300–7.CrossRefPubMed Miyatani K, Saito H, Kono Y, et al. Combined analysis of the pre- and postoperative neutrophil-lymphocyte ratio predicts the outcomes of patients with gastric cancer. Surg Today. 2018;48(3):300–7.CrossRefPubMed
7.
go back to reference Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.CrossRefPubMed Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.CrossRefPubMed
8.
go back to reference Shoji F, Kozuma Y, Toyokawa G, et al. Complete blood cell count-derived inflammatory biomarkers in early-stage non-small-cell lung cancer. Ann Thorac Cardiovasc Surg. 2020;26(5):248–55.CrossRefPubMedPubMedCentral Shoji F, Kozuma Y, Toyokawa G, et al. Complete blood cell count-derived inflammatory biomarkers in early-stage non-small-cell lung cancer. Ann Thorac Cardiovasc Surg. 2020;26(5):248–55.CrossRefPubMedPubMedCentral
9.
10.
go back to reference Chao B, Ju X, Zhang L, et al. A novel prognostic marker systemic inflammation response index (SIRI) for operable cervical cancer patients. Front Oncol. 2020;10:766.CrossRefPubMedPubMedCentral Chao B, Ju X, Zhang L, et al. A novel prognostic marker systemic inflammation response index (SIRI) for operable cervical cancer patients. Front Oncol. 2020;10:766.CrossRefPubMedPubMedCentral
11.
go back to reference Huang H, Liu Q, Zhu L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep. 2019;9(1):3284.CrossRefPubMedPubMedCentral Huang H, Liu Q, Zhu L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep. 2019;9(1):3284.CrossRefPubMedPubMedCentral
12.
go back to reference Li Z, Hong N, Robertson M, et al. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer. Sci Rep. 2017;7:43001.CrossRefPubMedPubMedCentral Li Z, Hong N, Robertson M, et al. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer. Sci Rep. 2017;7:43001.CrossRefPubMedPubMedCentral
13.
go back to reference Abu-Shawer O, Abu-Shawer M, Hirmas N, et al. Hematologic markers of distant metastases and poor prognosis in gynecological cancers. BMC Cancer. 2019;19(1):141.CrossRefPubMedPubMedCentral Abu-Shawer O, Abu-Shawer M, Hirmas N, et al. Hematologic markers of distant metastases and poor prognosis in gynecological cancers. BMC Cancer. 2019;19(1):141.CrossRefPubMedPubMedCentral
14.
go back to reference Chen L, Zhang F, Sheng XG, et al. Decreased pretreatment lymphocyte/monocyte ratio is associated with poor prognosis in stage Ib1-IIa cervical cancer patients who undergo radical surgery. Onco Targets Ther. 2015;8:1355–62.PubMedPubMedCentral Chen L, Zhang F, Sheng XG, et al. Decreased pretreatment lymphocyte/monocyte ratio is associated with poor prognosis in stage Ib1-IIa cervical cancer patients who undergo radical surgery. Onco Targets Ther. 2015;8:1355–62.PubMedPubMedCentral
15.
go back to reference Jung SW, Park IJ, Oh SH, et al. Association of immunologic markers from complete blood counts with the response to preoperative chemoradiotherapy and prognosis in locally advanced rectal cancer. Oncotarget. 2017;8(35):59757–65.CrossRefPubMedPubMedCentral Jung SW, Park IJ, Oh SH, et al. Association of immunologic markers from complete blood counts with the response to preoperative chemoradiotherapy and prognosis in locally advanced rectal cancer. Oncotarget. 2017;8(35):59757–65.CrossRefPubMedPubMedCentral
16.
go back to reference Henriksen JR, Nederby L, Donskov F, et al. Prognostic significance of baseline T cells, B cells and neutrophil-lymphocyte ratio (NLR) in recurrent ovarian cancer treated with chemotherapy. J Ovarian Res. 2020;13(1):59.CrossRefPubMedPubMedCentral Henriksen JR, Nederby L, Donskov F, et al. Prognostic significance of baseline T cells, B cells and neutrophil-lymphocyte ratio (NLR) in recurrent ovarian cancer treated with chemotherapy. J Ovarian Res. 2020;13(1):59.CrossRefPubMedPubMedCentral
17.
go back to reference Salman L, Ben-Haroush A, Raban O, et al. Neoadjuvant chemotherapy treatment modifications in ovarian carcinoma: the impact on surgical outcome and progression-free survival. Am J Clin Oncol. 2019;42(1):17–20.CrossRefPubMed Salman L, Ben-Haroush A, Raban O, et al. Neoadjuvant chemotherapy treatment modifications in ovarian carcinoma: the impact on surgical outcome and progression-free survival. Am J Clin Oncol. 2019;42(1):17–20.CrossRefPubMed
18.
go back to reference Prabawa I, Bhargah A, Liwang F, et al. Pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as a predictive value of hematological markers in cervical cancer. Asian Pac J Cancer Prev. 2019;20(3):863–8.CrossRefPubMedPubMedCentral Prabawa I, Bhargah A, Liwang F, et al. Pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as a predictive value of hematological markers in cervical cancer. Asian Pac J Cancer Prev. 2019;20(3):863–8.CrossRefPubMedPubMedCentral
19.
go back to reference Catabay C, Obi Y, Streja E, et al. Lymphocyte cell ratios and mortality among incident hemodialysis patients. Am J Nephrol. 2017;46(5):408–16.CrossRefPubMed Catabay C, Obi Y, Streja E, et al. Lymphocyte cell ratios and mortality among incident hemodialysis patients. Am J Nephrol. 2017;46(5):408–16.CrossRefPubMed
20.
go back to reference Ceran MU, Tasdemir U, Colak E, et al. Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis?—a survival analysis. J Ovarian Res. 2019;12(1):16.CrossRefPubMedPubMedCentral Ceran MU, Tasdemir U, Colak E, et al. Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis?—a survival analysis. J Ovarian Res. 2019;12(1):16.CrossRefPubMedPubMedCentral
21.
go back to reference Acmaz G, Aksoy H, Unal D, et al. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev. 2014;15(4):1689–92.CrossRefPubMed Acmaz G, Aksoy H, Unal D, et al. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev. 2014;15(4):1689–92.CrossRefPubMed
22.
go back to reference Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015;113(2):311–20.CrossRefPubMedPubMedCentral Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015;113(2):311–20.CrossRefPubMedPubMedCentral
23.
go back to reference Kurtoglu E, Kokcu A, Celik H, et al. Platelet indices may be useful in discrimination of benign and malign endometrial lesions, and early and advanced stage endometrial cancer. Asian Pac J Cancer Prev. 2015;16(13):5397–400.CrossRefPubMed Kurtoglu E, Kokcu A, Celik H, et al. Platelet indices may be useful in discrimination of benign and malign endometrial lesions, and early and advanced stage endometrial cancer. Asian Pac J Cancer Prev. 2015;16(13):5397–400.CrossRefPubMed
24.
go back to reference Haruma T, Nakamura K, Nishida T, et al. Pre-treatment neutrophil to lymphocyte ratio is a predictor of prognosis in endometrial cancer. Anticancer Res. 2015;35(1):337–43.PubMed Haruma T, Nakamura K, Nishida T, et al. Pre-treatment neutrophil to lymphocyte ratio is a predictor of prognosis in endometrial cancer. Anticancer Res. 2015;35(1):337–43.PubMed
25.
go back to reference Li J, Lin J, Luo Y, et al. Multivariate analysis of prognostic biomarkers in surgically treated endometrial cancer. PLoS ONE. 2015;10(6): e130640.CrossRef Li J, Lin J, Luo Y, et al. Multivariate analysis of prognostic biomarkers in surgically treated endometrial cancer. PLoS ONE. 2015;10(6): e130640.CrossRef
26.
go back to reference Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer. 2019;19(1):672.CrossRefPubMedPubMedCentral Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer. 2019;19(1):672.CrossRefPubMedPubMedCentral
27.
go back to reference Janowska-Wieczorek A, Wysoczynski M, Kijowski J, et al. Microvesicles derived from activated platelets induce metastasis and angiogenesis in lung cancer. Int J Cancer. 2005;113(5):752–60.CrossRefPubMed Janowska-Wieczorek A, Wysoczynski M, Kijowski J, et al. Microvesicles derived from activated platelets induce metastasis and angiogenesis in lung cancer. Int J Cancer. 2005;113(5):752–60.CrossRefPubMed
28.
go back to reference Ni L, Tao J, Xu J, et al. Prognostic values of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet. 2020;301(1):251–61.CrossRefPubMed Ni L, Tao J, Xu J, et al. Prognostic values of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet. 2020;301(1):251–61.CrossRefPubMed
29.
go back to reference Shibutani M, Maeda K, Nagahara H, et al. The peripheral monocyte count is associated with the density of tumor-associated macrophages in the tumor microenvironment of colorectal cancer: a retrospective study. BMC Cancer. 2017;17(1):404.CrossRefPubMedPubMedCentral Shibutani M, Maeda K, Nagahara H, et al. The peripheral monocyte count is associated with the density of tumor-associated macrophages in the tumor microenvironment of colorectal cancer: a retrospective study. BMC Cancer. 2017;17(1):404.CrossRefPubMedPubMedCentral
30.
go back to reference Zhu Q, Wu X, Wang X. Differential distribution of tumor-associated macrophages and Treg/Th17 cells in the progression of malignant and benign epithelial ovarian tumors. Oncol Lett. 2017;13(1):159–66.CrossRefPubMed Zhu Q, Wu X, Wang X. Differential distribution of tumor-associated macrophages and Treg/Th17 cells in the progression of malignant and benign epithelial ovarian tumors. Oncol Lett. 2017;13(1):159–66.CrossRefPubMed
31.
go back to reference Wongrakpanich S, George G, Chaiwatcharayut W, et al. The prognostic significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with multiple myeloma. J Clin Lab Anal. 2016;30(6):1208–13.CrossRefPubMedPubMedCentral Wongrakpanich S, George G, Chaiwatcharayut W, et al. The prognostic significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with multiple myeloma. J Clin Lab Anal. 2016;30(6):1208–13.CrossRefPubMedPubMedCentral
32.
go back to reference Feng F, Zheng G, Wang Q, et al. Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. BMC Gastroenterol. 2018;18(1):148.CrossRefPubMedPubMedCentral Feng F, Zheng G, Wang Q, et al. Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. BMC Gastroenterol. 2018;18(1):148.CrossRefPubMedPubMedCentral
33.
go back to reference Huang Y, Deng W, Zheng S, et al. Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis. Int Immunopharmacol. 2018;57:43–6.CrossRefPubMed Huang Y, Deng W, Zheng S, et al. Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis. Int Immunopharmacol. 2018;57:43–6.CrossRefPubMed
34.
go back to reference Wong L, Bozhilov K, Hernandez B, et al. Underlying liver disease and advanced stage liver cancer are associated with elevated neutrophil-lymphocyte ratio. Clin Mol Hepatol. 2019;25(3):305–16.CrossRefPubMedPubMedCentral Wong L, Bozhilov K, Hernandez B, et al. Underlying liver disease and advanced stage liver cancer are associated with elevated neutrophil-lymphocyte ratio. Clin Mol Hepatol. 2019;25(3):305–16.CrossRefPubMedPubMedCentral
35.
go back to reference Eo WK, Kwon S, Koh SB, et al. The lymphocyte-monocyte ratio predicts patient survival and aggressiveness of endometrial cancer. J Cancer. 2016;7(5):538–45.CrossRefPubMedPubMedCentral Eo WK, Kwon S, Koh SB, et al. The lymphocyte-monocyte ratio predicts patient survival and aggressiveness of endometrial cancer. J Cancer. 2016;7(5):538–45.CrossRefPubMedPubMedCentral
36.
go back to reference Song H, Jeong MJ, Cha J, et al. Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer. Int J Med Sci. 2021;18(16):3712–7.CrossRefPubMedPubMedCentral Song H, Jeong MJ, Cha J, et al. Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer. Int J Med Sci. 2021;18(16):3712–7.CrossRefPubMedPubMedCentral
37.
go back to reference Njoku K, Ramchander NC, Wan YL, et al. Pre-treatment inflammatory parameters predict survival from endometrial cancer: a prospective database analysis. Gynecol Oncol. 2022;164(1):146–53.CrossRefPubMedPubMedCentral Njoku K, Ramchander NC, Wan YL, et al. Pre-treatment inflammatory parameters predict survival from endometrial cancer: a prospective database analysis. Gynecol Oncol. 2022;164(1):146–53.CrossRefPubMedPubMedCentral
38.
go back to reference Cong R, Kong F, Ma J, et al. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer. 2020;20(1):464.CrossRefPubMedPubMedCentral Cong R, Kong F, Ma J, et al. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer. 2020;20(1):464.CrossRefPubMedPubMedCentral
39.
go back to reference Holub K, Busato F, Gouy S, et al. Analysis of systemic inflammatory factors and survival outcomes in endometrial cancer patients staged I-III FIGO and treated with postoperative external radiotherapy. J Clin Med. 2020;9(5):1441.CrossRefPubMedPubMedCentral Holub K, Busato F, Gouy S, et al. Analysis of systemic inflammatory factors and survival outcomes in endometrial cancer patients staged I-III FIGO and treated with postoperative external radiotherapy. J Clin Med. 2020;9(5):1441.CrossRefPubMedPubMedCentral
Metadata
Title
The predictive value of NLR, PLR and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors
Author
Lin Qin
Publication date
01-12-2024
Publisher
Springer US
Published in
Discover Oncology / Issue 1/2024
Print ISSN: 1868-8497
Electronic ISSN: 2730-6011
DOI
https://doi.org/10.1007/s12672-024-00956-8

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