title: Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison.
abstract: BACKGROUND
  Uterine sarcomas are rare among all uterine malignancies, and frequently misdiagnosed as benign uterine diseases such as leiomyoma and adenomyosis because of lack of feasible tools for the preoperative diagnosis. Although some studies have suggested the role of serum CA-125 levels for the preoperative diagnosis, the efficacy is controversial. Since malignancy is known to be associated with systemic inflammation which leads to hematological alteration, we compared the efficacy for the preoperative diagnosis of uterine sarcomas between the neutrophil to lymphocyte ratio (NLR) and serum CA-125 levels using a case-match comparison.
  
  
  METHODS
  From November 2004 to December 2008, 55 patients with carcinosarcoma (n=21), leiomyosarcoma (n=20) and endometrial stromal sarcoma (n=14) were matched to 330 patients with leiomyoma (n=165) and adenomyosis (n=165) in terms of age at diagnosis, body mass index and uterine volume.
  
  
  RESULTS
  The receiver operating characteristic curve showed the best cut-off values of the NLR (>or=2.12) and serum CA-125 levels (>or=27.5U/ml) for the preoperative diagnosis of uterine sarcomas, demonstrating that the NLR was more powerful for the preoperative diagnosis of uterine sarcomas than serum CA-125 levels (sensitivity, 74.5% vs. 52.3%; specificity, 70.3% vs. 50.5%; positive predictive value, 29.5% vs. 15.1%; negative predictive value, 94.3% vs. 86.5%; accuracy, 60.6% vs. 49.6%; p<0.05). Furthermore, the NLR reflected recurrence and progression more accurately than serum CA-125 levels in patients with uterine sarcomas.
  
  
  CONCLUSIONS
  These findings suggest that the NLR may be more useful than serum CA-125 levels as a cost-effective tool for the preoperative diagnosis in patients with uterine sarcomas.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yeongun-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: K H
authors.initials: KH
authors.lastname: Han
authors.forename: H H
authors.initials: HH
authors.lastname: Chung
authors.forename: J W
authors.initials: JW
authors.lastname: Kim
authors.forename: N H
authors.initials: NH
authors.lastname: Park
authors.forename: Y S
authors.initials: YS
authors.lastname: Song
authors.forename: S B
authors.initials: SB
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D002296:Carcinosarcoma / Q000097:blood / Q000175:diagnosis; D016022:Case-Control Studies; D004715:Endometriosis / Q000097:blood / Q000175:diagnosis; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000097:blood / Q000175:diagnosis; D007890:Leiomyosarcoma / Q000097:blood / Q000175:diagnosis; D008214:Lymphocytes; D008875:Middle Aged; D009504:Neutrophils; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012372:ROC Curve; D012107:Research Design; D012189:Retrospective Studies; D018401:Sample Size; D012509:Sarcoma / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D018203:Sarcoma, Endometrial Stromal / Q000097:blood / Q000175:diagnosis; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen