title: Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival.
abstract: BACKGROUND
  Variations in systemic inflammatory response biomarker levels have been associated with adverse clinical outcome in various malignancies. This study determined the prognostic significance of preoperative neutrophil:lymphocyte (NLR), platelet:lymphocyte (PLR) and monocyte:lymphocyte (MLR) ratios in endometrial cancer.
  
  
  METHODS
  Clinicopathological and 5-year follow-up data were obtained for a retrospective series of surgically treated endometrial cancer patients (n=605). Prognostic significance was determined for overall (OS) and cancer-specific survival (CSS) using Cox proportional hazards models and Kaplan-Meier analysis. Receiver-operator characteristic and log-rank functions were used to optimise cut-offs. NLR, PLR and MLR associations with clinicopathological variables were determined using non-parametric tests.
  
  
  RESULTS
  Applying cut-offs of ⩾2.4 (NLR), ⩾240 (PLR) and ⩾0.19 (MLR), NLR and PLR (but not MLR) had independent prognostic significance. Combining NLR and PLR scores stratified patients into low (NLR-low and PLR-low), intermediate (NLR-high or PLR-high) and high risk (NLR-high and PLR-high) groups: multivariable hazard ratio (HR) 2.51; P<0.001 (OS); HR 2.26; P<0.01 (CSS) for high vs low risk patients. Increased NLR and PLR were most strongly associated with advanced stage (P<0.001), whereas increased MLR was strongly associated with older age (P<0.001).
  
  
  CONCLUSIONS
  Both NLR and PLR are independent prognostic indicators for endometrial cancer, which can be combined to provide additional patient stratification.
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cummings
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: L
authors.initials: L
authors.lastname: Merone
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, Division of Epidemiology and Biostatistics, University of Leeds, Leeds LS2 9JT, UK.
authors.forename: C
authors.initials: C
authors.lastname: Keeble
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: L
authors.initials: L
authors.lastname: Burland
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Grzelinski
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: K
authors.initials: K
authors.lastname: Sutton
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: N
authors.initials: N
authors.lastname: Begum
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thacoor
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: B
authors.initials: B
authors.lastname: Green
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sarveswaran
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hutson
authors.affiliation: Women's Health Research Group, Leeds Institute of Cancer and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Orsi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets; D016889:Endometrial Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008214:Lymphocytes; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies