| Objective:By retrospectively analyzing the data of preoperative clinicopathological parameters of 217 patients with endometrial atypical hyperplasia(AH),we explored the risk factors affecting the progression of AH patients and their correlation with clinicopathological features,and then made risk prediction for the postoperative pathological escalation status of clinical AH patients,so as to provide a theoretical basis for clinical decision making and the choice of treatment modality for patients.Method:The clinicopathological details of patients who attended the gynecology department for endometrial atypical hyperplasia and underwent total hysterectomy between January 2013 and January 2023 in Jiangsu Subei people’s Hospital were collected for retrospective analysis,and they were split into two groups,the endometrial atypical hyperplasia group(control group)and the endometrial cancer group(EC group),based on the pathological report outcome of the postoperative whole uterus surgical specimens sent for surgery.General clinical file data,preoperative laboratory hematological clinical parameter indices and postoperative routine pathological traits of all participants were collected,and restricted to the construction of subject operating characteristic curves(ROC curves)by logistic regression equations to analyze and study the diagnostic value of multiple clinicopathological parameter indices individually and in combination on the status of AH postoperative pathological escalation,and the ROC curves were applied to determine each relevant index.The ROC curves were used to determine the critical threshold values(cut-off values)for diagnosing the evolution of endometrial AH,to correlate the clinical parameters with the pathological profile of patients in the EC group according to the relative cut-off values,to compare the diagnostic efficacy of the indicators under the AUC,and to probe the risk criteria for postoperative pathological escalation in patients with endometrial atypical hyperplasia and to engage in risk assessment.Result:1.80 of the 217 patients with endometrial atypical hyperplasia in this study had postoperative pathological upgrades suggesting concurrent endometrial cancer,i.e.,the cancer rate was 36.86%,and the pathological types were all endometrioid adenocarcinoma.68(85%)patients in the EC group had FIGO surgical-pathological stage IA,8(10%)stage IB,and 4(5%)stage II.There were no stage III or IV patients,and the histopathological differentiation was predominantly highly differentiated in 48 cases(60%).2.The distinction in age,menopausal status,duration of menopause,preoperative sampling to total uterine surgery interval and preoperative hematological univariate indices NLR,PLR,LMR,FIB,SII,CA125,CA199 and HE4 was statistically significant(P<0.05)in the two groups with regard to the nature of the diagnosis of AH,while the differences in BMI,comorbidities,fertility status,first clinical presentation at the consultation,preoperative There was no statistically significant difference in the endometrial thickness,MLR,PNI and CA199 levels measured by the method of obtaining endometrial tissue and imaging examinations(P>0.05).3.The AUC for diagnostic efficacy of EC predicted by ROC curve screening was 0.586,0.704,0.608,0.647,0.719,0.712,0.723,and 0.718 for length of menopause,NLR,PLR,LMR,FIB,CA125,HE4,and SII alone,respectively,with NLR,FIB,CA125,and HE4 and SII five had moderate diagnostic efficacy for EC,and their optimum threshold values were 2.125,2.71 g/L,19.03 U/Ml,53.53 pmol/L and 551.625,respectively.4.The surgical pathological staging and the difference in the depth of myofilament infiltration in the high NLR,PLR,and CA125 level groups correlated with the differences in surgical pathological staging and the depth of myofilament infiltration in patients with lowlevel EC during the same period.The differences in surgical-pathological staging,degree of histological division and depth of myxomatous infiltration between the high HE4 and SII level groups and the low level EC patients during the same period were correlated,while the LMR and FIB cluster levels were not clearly correlated with the FIGO surgical-pathological staging,histological grading,depth of myxomatous invasion and degree of cervical involvement in EC patients(P>0.05).5.The correlation variance between the three indicators PLR,NLR and SII using Origin’s Correlation Hot analysis was statistically significance,while there was no apparent correlation between CA125,HE4 and inflammatory indicators.Finally,four hematological indicators of tumor markers CA125,HE4 and inflammatory nutritional indicators FIB and SII were included in the joint diagnostic screening to predict EC validity,and the diagnostic liquidity of several joint indicators was higher than the index of stand-alone prediction of single indicators,in which the AUC value of the joint prediction of EC by all four was 0.911,sensitivity 86.30%,specificity 83.20%and Yordon index 0.695.Conclusion:1.In this case,the incidence of postoperative pathological progression to endometrial cancer in atypical endometrial hyperplasia patients was 36.86%,and most of those patients had relatively early differentiated endometrioid adenocarcinoma.2.The peripheral blood inflammatory trophic indexes NLR,PLR,FIB and SII levels were higher and LMR levels were lower in the EC group,and these relevant indexes are potential predictors of disease progression in AH patients as a simple and easy non-invasive preoperative test.3.The grouping of serum NLR,PLR,SII,CA125,and HE4 levels associated with the surgical pathological stroke status and the depth of myometrial infiltration in patients with endometrial cancer can help to assess and predict the pathological features such as operative pathological stage,histological scale,index of myometrial infiltration and cervical involvement in cases with presurgical suspected morbid escalation.4.Immunoinflammatory hematologic parameters plus tumor markers are more accurate and sensitive for determining and supervising the progression of endometrial atypical proliferative lesions compared to single hematologic markers... |
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