Pretreatment Inflammatory Indices as Predictors of Survival in Endometrial Cancer: A Retrospective Cohort Study From Mexico

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INTRODUCTION: Nutritional and inflammatory prognostic indices derived from biochemical and hematological parameters are emerging as potential prognostic biomarkers in various malignancies, including endometrial cancer. OBJECTIVE: The objective of this study is to evaluate whether pre-treatment biomarkers of systemic inflammation are associated with survival outcomes in patients with endometrial cancer. METHODS: This retrospective cohort study included women treated for endometrial cancer at a single institution. Pre-treatment Onodera's Prognostic Nutritional Index (PNI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and Systemic Immune-Inflammation Index (SIII) were calculated, with cutoff values determined using receiver operating characteristic (ROC) curves and quartiles. Associations with overall survival (OS) were analyzed using Kaplan-Meier estimation and multivariable Cox proportional regression, adjusting for the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, grade, and adjuvant therapy. Odds ratios (ORs) were used due to the retrospective design. RESULTS: We included 887 patients who underwent initial staging surgery between 1997 and 2019. The median age was 55.27 years, with a median follow-up of 59.63 months. High NLR (>2.8, OR 1.90, 95% confidence interval (CI): 1.26-2.87, p=0.002) and PLR (>103.2) and low LMR (<4.8, OR 2.09, 95% CI 1.39-3.15, p<0.001, area under the curve (AUC) 0.589, 95% CI 0.54-0.64) and PNI (<40.0) were associated with reduced five-year OS. The LMR demonstrated the highest, though modest, precision in AUC analysis and was significantly associated with OS and mortality risk. These indices may guide adjuvant therapy decisions in resource-limited settings. CONCLUSION: Pre-treatment inflammatory indices, particularly LMR, are promising prognostic biomarkers for OS in endometrial cancer, offering accessible tools for risk stratification in low-middle-income settings. These indices should not replace established clinical prognosticators but may provide additive value. Prospective, multicenter studies are needed to confirm these findings and integrate them into clinical practice.

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