Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Subjects
2.2. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Univariate and Multivariate Analysis
3.3. Subgroup Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Total | Low NLR Group | High NLR Group | p Value | ||
---|---|---|---|---|---|
n = 99 | n = 50 | n = 49 | |||
Age (years) | ≥60 | 21 (21.2) 1 | 10 (20.0) | 11 (22.4) | 0.766 |
<60 | 78 (78.8) | 40 (80.0) | 38 (77.6) | ||
BMI (kg/m2) | Normal (18.5–22.9) | 41 (41.4) | 21 (42.0) | 20 (40.8) | 0.905 |
Overweight (≥23) | 58 (58.6) | 29 (58.0) | 29 (59.2) | ||
Hypertension | Yes | 25 (25.3) | 14 (28.0) | 11 (22.4) | 0.525 |
No | 74 (74.7) | 36 (72.0) | 38 (77.6) | ||
Diabetes | Yes | 14 (14.1) | 8 (16.0) | 6 (12.2) | 0.592 |
No | 85 (85.9) | 42 (84.0) | 43 (87.8) | ||
Histologic type | LMS | 57 (57.6) | 27 (54.0) | 30 (61.2) | 0.433 |
ESS | 29 (29.3) | 17 (34.0) | 12 (24.5) | ||
UUS | 7 (7.1) | 2 (4.0) | 5 (10.2) | ||
Adenosarcoma | 6 (6.1) | 4 (8.0) | 2 (4.1) | ||
Stage (FIGO) | I | 73 (73.7) | 39 (78.0) | 34 (69.4) | 0.801 |
II | 7 (7.1) | 3 (6.0) | 4 (8.2) | ||
III | 8 (8.1) | 3 (6.0) | 5 (10.2) | ||
IV | 11 (11.1) | 5 (10.0) | 6 (12.2) | ||
Tumor size (cm) | ≥5 | 36 (36.4) | 35 (70.0) | 44 (89.9) | 0.014 |
<5 | 63 (63.6) | 15 (30.0) | 5 (10.2) | ||
Mitotic index | ≥15 | 44 (44.4) | 20 (40.0) | 24 (49.0) | 0.369 |
(MF/10HPF) | <15 | 55 (55.6) | 30 (60.0) | 25 (51.0) | |
Nuclear atypia | ≥severe | 20 (20.2) | 8 (16.0) | 12 (24.5) | 0.293 |
<severe | 79 (79.8) | 42 (84.0) | 37 (75.5) | ||
Vascular invasion | Yes | 24 (24.2) | 12 (24.0) | 12 (24.5) | 0.955 |
No | 75 (75.8) | 38 (76.0) | 37 (75.5) | ||
Tumor necrosis | Yes | 74 (74.7) | 33 (66.0) | 41 (83.7) | 0.043 |
No | 25 (25.3) | 17 (34.0) | 8 (16.3) | ||
Lymphadenectomy | Yes | 29 (29.3) | 13 (26.0) | 16 (32.7) | 0.467 |
No | 70 (70.7) | 37 (74.0) | 33 (67.3) | ||
Recurrence | Yes | 30 (30.3) | 9 (18.0) | 21 (42.9) | 0.007 |
No | 69 (69.7) | 37 (74.0) | 28 (57.1) | ||
CA-125 (U/mL) 2 | <35 | 68 (68.7) | 31 (79.5) | 23 (67.6) | 0.250 |
≥35 | 31 (31.3) | 8 (20.5) | 34 (32.4) | ||
LDH (U/L) 2 | <271 | 29 (29.3) | 8 (20.5) | 9 (26.5) | 0.548 |
≥271 | 70 (70.7) | 31 (79.5) | 25 (73.5) |
Univariate | Multivariate | |||
---|---|---|---|---|
HR (95% CI) | p Value | Adjusted HR (95% CI) | p Value | |
Age (years) | 0.141 | |||
≥60 | 1.74 (0.82–3.82) 1 | |||
<60 | 1.00 (Ref.) | |||
Histology | 0.048 | 0.498 | ||
LMS | 2.20 (1.00–4.82) | 0.72(0.28–1.86) | ||
Others | 1.00 (Ref.) | 1.00 (Ref.) | ||
Stage (FIGO) | <0.001 | 0.017 | ||
I/II | 1.00 (Ref.) | 1.00 (Ref.) | ||
III/IV | 4.71 (2.24–9.91) | 2.95 (1.21–7.20) | ||
Tumor size (cm) | 0.107 | |||
≥5 | 2.94 (0.79–10.93) | |||
<5 | 1.00 (Ref.) | |||
Mitotic index (MF/10HPF) | 0.004 | 0.036 | ||
≥15 | 2.98 (1.42–6.26) | 2.59 (1.06–6.28) | ||
<15 | 1.00 (Ref.) | 1.00 (Ref.) | ||
Nuclear atypia | 0.229 | |||
≥severe | 1.68 (0.72–3.95) | |||
<severe | 1.00 (Ref.) | |||
Vascular invasion | 0.901 | |||
Yes | 1.05 (0.45–2.47) | |||
No | 1.00 (Ref.) | |||
Tumor necrosis | 0.102 | |||
Yes | 2.41 (0.84–6.95) | |||
No | 1.00 (Ref.) | |||
CA-125 (U/mL) 2 | 0.450 | |||
≥35 | 1.42 (0.57–3.51) | |||
<35 | 1.00 (Ref.) | |||
LDH (U/L) 2 | 0.761 | |||
≥271 | 1.22 (0.34–4.37) | |||
<271 | 1.00 (Ref.) | |||
NLR | 0.009 | 0.007 | ||
≥2.60 | 3.41 (1.37–8.58) | 3.58 (1.42–9.00) | ||
<2.60 | 1.00 (Ref.) | 1.00 (Ref.) | ||
PLR | 0.009 | 0.363 | ||
≥141.12 | 4.71 (1.48–14.97) | 1.90 (0.48–1.57) | ||
<141.12 | 1.00 (Ref.) | 1.00 (Ref.) |
Univariate | Multivariate | |||
---|---|---|---|---|
HR (95% CI) | p Value | Adjusted HR (95% CI) | p Value | |
Age (years) | 0.271 | |||
≥60 | 1.74 (0.65–4.62) 1 | |||
<60 | 1.00 (Ref.) | |||
Histology | 0.024 | 0.326 | ||
LMS | 4.16 (1.20–14.40) | 0.47 (0.10–2.13) | ||
Others | 1.00 (Ref.) | 1.00 (Ref.) | ||
Stage (FIGO) | <0.001 | 0.015 | ||
I/II | 1.00 (Ref.) | 1.00 (Ref.) | ||
III/IV | 5.33 (2.10–13.55) | 3.32 (1.26–8.75) | ||
Tumor size (cm) | 0.768 | |||
≥5 | 1.00 (Ref.) | |||
<5 | 0.91 (0.28–2.50) | |||
Mitotic index (MF/10HPF) | 0.010 | 0.005 | ||
≥15 | 3.63 (1.36–9.60) | 6.01 (1.71–21.20) | ||
<15 | 1.00 (Ref.) | 1.00 (Ref.) | ||
Nuclear atypia | 0.031 | 0.195 | ||
≥severe | 2.93 (1.10–7.83) | 2.19 (0.67–7.16) | ||
<severe | 1.00 (Ref.) | 1.00 (Ref.) | ||
Vascular invasion | 0.578 | |||
Yes | 1.00 (Ref.) | |||
No | 0.70 (0.20–2.43) | |||
Tumor necrosis | 0.386 | |||
Yes | 1.73 (0.50–5.98) | |||
No | 1.00 (Ref.) | |||
CA-125 (U/mL) 2 | 0.445 | |||
≥35 | 1.51 (0.52–4.37) | |||
<35 | 1.00 (Ref.) | |||
LDH (U/L) 2 | 0.902 | |||
≥271 | 1.90 (0.27–4.48) | |||
<271 | 1.00 (Ref.) | |||
NLR | 0.039 | 0.039 | ||
≥2.60 | 3.25 (1.06–9.97) | 3.27 (1.06–10.08) | ||
<2.60 | 1.00 (Ref.) | 1.00 (Ref.) | ||
PLR | 0.581 | |||
≥141.12 | 1.37 (0.45–4.25) | |||
<141.12 | 1.00 (Ref.) |
Total | Low NLR Group | High NLR Group | p Value | ||
---|---|---|---|---|---|
n = 73 | n = 39 | n = 34 | |||
Age (years) | ≥60 | 15 (20.5) 1 | 7 (17.9) | 8 (23.5) | 0.556 |
<60 | 58 (79.5) | 32 (82.1) | 26 (76.5) | ||
BMI (kg/m2) | Normal (18.5–22.9) | 30 (41.1) | 17 (43.6) | 21 (61.8) | 0.643 |
Overweight (≥23) | 43 (58.9) | 22 (56.4) | 13 (38.2) | ||
Hypertension | Yes | 18 (24.7) | 9 (23.1) | 9 (26.5) | 0.737 |
No | 55 (75.3) | 30 (76.9) | 25 (73.5) | ||
Diabetes | Yes | 11 (15.1) | 5 (12.8) | 6 (17.6) | 0.565 |
No | 62 (84.9) | 34 (87.2) | 28 (82.4) | ||
Histologic type | LMS | 37 (50.7) | 17 (43.6) | 20 (58.8) | 0.144 |
ESS | 23 (31.5) | 16 (41.0) | 7 (20.6) | ||
UUS | 7 (9.6) | 2 (5.1) | 5 (14.7) | ||
Adenosarcoma | 6 (8.2) | 4 (10.3) | 2 (5.9) | ||
Tumor size (cm) | ≥5 | 54 (74.0) | 24 (61.5) | 29 (85.3) | 0.023 |
<5 | 19 (26.0) | 15 (38.5) | 5 (14.7) | ||
Mitotic index | ≥15 | 26 (35.6) | 12 (30.8) | 14 (41.2) | 0.354 |
(MF/10HPF) | <15 | 47 (64.4) | 27 (69.2) | 20 (58.8) | |
Nuclear atypia | ≥severe | 13 (17.8) | 5 (12.8) | 8 (23.5) | 0.233 |
<severe | 60 (82.2) | 34 (87.2) | 26 (76.5) | ||
Vascular invasion | Yes | 17 (23.3) | 9 (23.1) | 8 (23.5) | 0.964 |
No | 56 (76.7) | 30 (76.9) | 26 (76.5) | ||
Tumor necrosis | Yes | 50 (68.5) | 23 (59.0) | 27 (79.4) | 0.061 |
No | 23 (31.5) | 16 (41.0) | 7 (20.6) | ||
Lymphadenectomy | Yes | 17 (23.3) | 8 (20.5) | 9 (26.5) | 0.548 |
No | 56 (76.7) | 31 (79.5) | 25 (73.5) | ||
Recurrence | Yes | 15 (20.5) | 4 (10.3) | 11 (32.4) | 0.020 |
No | 58 (79.5) | 35 (89.7) | 23 (67.6) | ||
CA-125 (U/mL) 2 | <35 | 54 (74.0) | 31 (79.5) | 23 (67.6) | 0.250 |
≥35 | 19 (26.0) | 8 (20.5) | 11 (32.4) | ||
LDH (U/L) 2 | <271 | 11 (15.1) | 6 (23.1) | 5 (26.5) | 0.682 |
≥271 | 42 (57.5) | 20 (76.9) | 22 (73.5) |
First author | Year | No. | Measurement | NLR Cutoff Value | Outcomes | Histopathology |
---|---|---|---|---|---|---|
Kim, H.S. [11] | 2010 | 34 | NLR, CA-125 | 2.12 | High NLR as a diagnostic marker | Uterine sarcoma |
High NLR with worse recurrence rate | ||||||
Cho, H.Y. [25] | 2016 | 31 | NLR | 2.1 | High NLR as a diagnostic marker | Uterine sarcoma |
Li, D. [12] | 2020 | 114 | NLR | 3.6 | High NLR with worse OS | Uterine sarcoma |
Zhang, G. [26] | 2020 | 45 | NLR, LDH, PLT | 2.8 | High NLR as a diagnostic marker | LMS |
Jeong, M.J. (present study) | 2020 | 99 | NLR, PLR, LDH, CA-125 | 2.6 | High NLR with worse OS | Uterine sarcoma |
High NLR with worse DFS |
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Jeong, M.J.; Park, J.H.; Hur, S.Y.; Kim, C.J.; Nam, H.S.; Lee, Y.S. Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma. J. Clin. Med. 2020, 9, 2898. https://doi.org/10.3390/jcm9092898
Jeong MJ, Park JH, Hur SY, Kim CJ, Nam HS, Lee YS. Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma. Journal of Clinical Medicine. 2020; 9(9):2898. https://doi.org/10.3390/jcm9092898
Chicago/Turabian StyleJeong, Min Jin, Jung Hyun Park, Soo Young Hur, Chan Joo Kim, Hae Seong Nam, and Yong Seok Lee. 2020. "Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma" Journal of Clinical Medicine 9, no. 9: 2898. https://doi.org/10.3390/jcm9092898