Pre-operative Neutrophil Lymphocyte Ratio As A Prognostic Factor In Endometrioid Endometrial Adenocarcinoma

Background and aim:A variety of studies demonstrated that the host’s immune response to cancer is expressed through the process of inflammation, and this inflammatory response have a hand in the process of tumor progression by releasing leukocytic and other phagocytic mediators or inflammatory cytokines that would induce damage to cellular DNA, inhibit apoptosis and promote angiogenesis around the tumor area, and finally these would ultimately lead to tumor growth and progression. On the contrary, whenever the inflammatory process is controlled or suppressed, the growth of tumor will be impeded. Abnormal hematologic report particularly leukocyte and its differential counts are also well recognized in association with the inflammatory process. Recently, some studies showed that neutrophil lymphocyte ratio (NLR) was associated with prognosis of patients with different type of malignant tumor. However, the prognostic value of NLR in endometriood endometrial adenocarcinoma is unclear. This study was designed to investigate the prognostic value of the neutrophil lymphocyte ratio (NLR) in endometrioid endometrial adenocarcinoma.Material and method:212patients that undergone operations for endometrioid endometrial adenocarcinoma at Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, from January2005to December2009were retrospectively enrolled. Data collection included age, height, weight, body mass index (BMI), diabetes history, results of blood routine test (including leukocyte, neutrophil and lymphocyte counts), postoperative pathology reports, FIGO stage and so on. Statistical analysis was performed with the statistical package for the social sciences (SPSS) software package version19.0. The Wilcoxon rank sum test or two-sample t-test was used to compare the median and mean values between different group. The χ2test was used for categorical variables and the Fisher’s exact test was used if it is necessary. The overall survival was analyzed with the Kaplan-Meier method and was compared by log-rank test, and Cox regression model was used to analyze the factors which could affect the overall survival in univariable analysis and inultivariable analysis. Factors which were significant in univariate analysis were included in the following multivariate analysis using an enter procedure. The p-value of≤0.05was considered statistically significant.Results:The median NLR of these212patients with endometrioid endometrial adenocarcinoma in this retrospective study is2.05, with a range of0.68-10.21. When we divided the cohort according to the median NLR for statistical analysis, we found that the group with higher NLR (≥2.05) were younger in age(p=0.005), had more advanced staged disease in FIGO stage(p=0.012), owed a higher level of tumor grade(p=0.037) and represented a poorer survival outcomes (p=0.011)than the lower NLR group. In univariable analysis, age, NLR, FIGO stage and tumor grade had effects on the survival of patients with endometrioid endometrial adenocarcinoma(p-value are0.001,0.001,<0.001and<0.001respectively),In multivariable analysis, age, FIGO stage and NLR were identified as being independent prognostic factors for survival(p-value are<0.001,<0.001and0.001respectively).Conclusion:The level of pre-operative NLR may be a potential cost-effective biomarker and an independent predictor of survival in endometrioid endometrial adenocarcinoma.