Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in the differentiation of uterine leiomyoma and sarcoma: Inflammatory markers in the diagnosis of uterine sarcoma

Fazıl Avcı; Ahmet Bilgi; Çetin Çelik; Mehmet Kulhan

doi:10.5281/zenodo.8087973

Authors

Fazıl Avcı Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey https://orcid.org/0000-0002-9244-9168
Ahmet Bilgi Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey https://orcid.org/0000-0001-8682-1739
Çetin Çelik Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey https://orcid.org/0000-0001-6165-5092
Mehmet Kulhan Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey https://orcid.org/0000-0002-5478-7510

DOI:

https://doi.org/10.5281/zenodo.8087973

Keywords:

Inflammation, hematological parameters, leiomyoma, uterine sarcoma

Abstract

Objective: While uterine leiomyoma (LM) is frequently detected in women of reproductive age, uterine sarcoma is detected in the postmenopausal period and is diagnosed postoperatively. Inflammatory markers that facilitate the diagnosis of uterine sarcoma can be used predictively. We aimed to investigate the use of mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as prognostic factors in differentiating preoperative uterine LM and sarcoma.
Methods: In this study, we retrospectively evaluated cases diagnosed with uterine sarcoma and LM between January 2011 and December 2021. The clinicopathological features of 51 cases (group 1) diagnosed with uterine LM and 50 cases (group 2) diagnosed with uterine sarcoma were compared.
Results: The mean ages of the patients in group 1 and group 2 were 49.1±5.4 and 60.1±14.0 years, respectively (p=0.001). The age range of the cases, menopause status, gravida, parity, preoperative hemoglobin level, platelet levels (PLT), neutrophil levels, PLR, MPV and tumor mass size were not significant (p>0.05). The lymphocyte levels and NLR were significant between the groups (p<0.05). In the regression analysis, only the age variable was determined to be a significant risk factor.
Conclusion: Age, NLR and lymphocyte level were found to be significant factors in the differentiation of uterine LM and sarcoma, while MPV and PLR were not significant factors. Large randomized controlled studies are needed for definitive evidence-based results.

References

Nishigaya Y, Kobayashi Y, Matsuzawa Y, Hasegawa K, Fukasawa I, Watanabe Y, et al. Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma. J Obstet Gynaecol Res. 2019;45(1):189-94.

Mao J, Pfeifer S, Zheng XE, Schlegel P, Sedrakyan A. Population-based estimates of the prevalence of uterine sarcoma among patients with leiomyomata undergoing surgical treatment. JAMA Surg. 2015;150(4):368-70.

Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B. Uterine Sarcoma: Analysis of 13,089 Cases Based on Surveillance, Epidemiology, and End Results Database. Int J Gynecol Cancer. 2016;26(6):1098-104.

Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994;18(6):535-58.

Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993;15:71(4 Suppl):1702-9.

Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003;89(3):460-9.

Qiu LL, Yu RS, Chen Y, Zhang Q. Sarcomas of abdominal organs: computed tomography and magnetic resonance imaging findings. Semin Ultrasound CT MR. 2011;32(5):405-21.

Ota T, Huang KG, Sicam RV, Ueng SH, Lee CL. Unusual trocar site metastasis in a uterine leiomyosarcoma after laparoscopic hysterectomy. J Minim Invasive Gynecol. 2012;19(2):252-4.

Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;1:91(3):181-4.

Cho HY, Kim K, Kim YB, No JH. Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics. J Obstet Gynaecol Res. 2016;42(3):313-8.

Blake-Mortimer JS, Sephton SE, Carlson RW, Stites D, Spiegel D. Cytotoxic T lymphocyte count and survival time in women with metastatic breast cancer. Breast J. 2004;10(3):195-9.

Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008;34(1):55-60.

Leitch EF, Chakrabarti M, Crozier JE, Mc Kee RF, Anderson JH, Horgan PG, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;5:97(9):1266-70.

McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223-6.

Selen S, Kilic F, Kimyon Comert G, Unsal M, Kilic C, Karalok A, et al. Can preoperative inflammatory markers differentiate endometrial cancer from complex atypical hyperplasia/endometrial intraepithelial neoplasia? J Obstet Gynaecol Res. 2020;46(7):1148-56.

Eo WK, Kim KH, Park EJ, Kim HY, Kim HB, Koh SB, et al. Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses. J Cancer. 2018; 8:9(7):1165-72.

Yildirim M, Turkyilmaz E, Avsar AF. Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess. Gynecol Obstet Invest. 2015;80(4):234-9.

Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491-7.

Caglayan EK, Engin-Ustun Y, Gocmen AY, Sarı N, Seckin L, Kara M, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. 2016;44(3):315-20.

Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;19-26:420(6917):860-7.

Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073-81.

Ertürk Aksakal S, Korkmaz H, Korkmaz V. Can Preoperative Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and APRI Score Reliably Differentiate Uterine Sarcomas from Leiomyomas? Acta Oncologica Turcica. 2022;55:85-92.

Srisutha P, Santibenchakul S, Ariyasriwatana C, Oranratanaphan S. Neutrophil-to-Lymphocyte Ratio (NLR) for Preoperative Differentiation between Uterine Leiomyosarcoma (LMS) and Uterine Leiomyoma: A Case-Controlled Study. Asian Pac J Cancer Prev. 2023;1:24(2):701-7.

Zhang G, Yu X, Zhu L, Fan Q, Shi H, Lang J. Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid. BMC Cancer. 2020;3:20(1):514.

Kim HS, Han KH, Chung HH, Kim JW, Park NH, Song YS, et al. Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison. Eur J Surg Oncol. 2010;36(7):691-8.

Żak K ZB, Rajtak A, Kotarski J, Amant F, Bobiński M. Preoperative Differentiation of Uterine Leiomyomas and Leiomyosarcomas: Current Possibilities and Future Directions. Cancers (Basel). 2022;13:14(8):1966.