Prognostic value of circulating and tumor microenvironmental biomarkers in endometrial cancer

Aim: Endometrial cancer (EC) is one of the three most common gynecological malignancies. Thus, it is estimated that the mortality rates due to this disease will increase. Our aim is to study the immune microenvironment in all ECs together with Hematoxylin Eosin (H&E), immunohistochemical (IHC) and Biochemical parameters (NLR) and to evaluate their contribution to prognosis by comparing them with each other.

Materials and methods: A total of 340 EC patients were included in the study. PDL-1 immunohistochemical stain was applied to blocks prepared from representative tumor tissues by Tissue Microarray method. Tumor- infiltrating lymphocytes and neutrophils were also scored with Hematoxylin Eosin stain. The NLR values calculated from peripheral blood. The effects of all parameters on survival, recurrence/metastasis were statistically evaluated.

Results: Regarding TIL Scores, patients with higher TIL scores were found to have longer disease-free survival and total survival. In patients with high TIN scores, disease-free survival and overall survival were shorter. (p < 0.001) The overall survival of patients with PDL-1 negative was found to be longer. (p: 0.07). In terms of the effect on OS, an NLR cut-off value of 2.72 was determined (specificity 38.89 %, sensitivity 82.57 %, AUC 0.65). OS was 77.11 months ( ± 0.04, 95 % CI: 71.8-81.9) in the patients with NLR value slower than 2.72 and 76.5 months ( ± 1.3, 95 % CI: 36.3-63.7) in those with NLR ≥ 2.72 (p: 0.001).

Conclusion: In this study, all patients of EC with high TIL scores, low TIN scores, and with PD-L1 negativity exhibited significantly longer survival times. TIN appears to be a highly valuable parameter in terms of both OS and PFS, particularly compared to TIL and PD-L1. This research represent a pioneering study for future studies involving larger samples in the context of being able to use different parameters in predicting prognosis and treatment in patients with EC.