Vol 94, No 4 (2023)
Research paper
Published online: 2021-12-17

open access

Page views 2750
Article views/downloads 851
Get Citation

Connect on Social Media

Connect on Social Media

Platelet to lymphocyte and neutrophil to lymphocyte ratios in endometrial pathologies

Orkun Ilgen1, Sefa Kurt1, Resmiye Irmak Yuzuguldu2, Onur Ada1, Alper Mankan1
Pubmed: 35072230
Ginekol Pol 2023;94(4):269-274.


Objectives: Aim of this study was to evaluate the relationship between platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and endometrial pathologies.
Material and methods: The database of our institution was reviewed. Cases with endometrial pathology including endometrial cancer (EC), endometrial hyperplasia with atypia and without atypia, normal endometrial findings, between January 2015 to January 2020, were collected. Their CBC results and clinicopathologic data were determined. The relation between the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and endometrial pathologies was evaluated.
Results: NLR was significantly higher in patients with endometrial cancer compared to other endometrial pathologies including endometrial hyperplasia with and without atypia and patients with normal endometrial findings. NLR cut-off value was determined 3.55 to discriminate cancer among other endometrial pathologies. PLR had not a significant difference between the endometrial pathologies.
Conclusion: NLR seems to be an effective and simple marker to discriminate endometrial cancer among endometrial pathologies by contrast with PLR.

Article available in PDF format

View PDF Download PDF file


  1. Babu SN, Chetal G, Kumar S. Macrophage migration inhibitory factor: a potential marker for cancer diagnosis and therapy. Asian Pac J Cancer Prev. 2012; 13(5): 1737–1744.
  2. Guo YZ, Pan L, Du CJ, et al. Association between C-reactive protein and risk of cancer: a meta-analysis of prospective cohort studies. Asian Pac J Cancer Prev. 2013; 14(1): 243–248.
  3. Heller DS, Mosquera C, Goldsmith LT, et al. Body mass index of patients with endometrial hyperplasia: comparison to patients with proliferative endometrium and abnormal bleeding. J Reprod Med. 2011; 56(3–4): 110–112.
  4. Cong R, Kong F, Ma J, et al. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer. 2020; 20(1): 464.
  5. Kao SCH, Pavlakis N, Harvie R, et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010; 16(23): 5805–5813.
  6. Kwon HC, Kim SH, Oh SY, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012; 17(3): 216–222.
  7. Fridlender ZG, Sun J, Kim S, et al. Polarization of tumor-associated neutrophil phenotype by TGF-beta: ‘N1’ versus ‘N2’ TAN. Cancer Cell. 2009; 16(3): 183–194.
  8. Shaul ME, Fridlender ZG. Cancer-related circulating and tumor-associated neutrophils - subtypes, sources and function. FEBS J. 2018; 285(23): 4316–4342.
  9. Schernberg A. Neutrophilia as prognostic biomarker in locally advanced stage III lung cancer. PLoS One. 2018; 13(10): e0204490.
  10. Schernberg A, Escande A, Campo ER, et al. Leukocytosis and neutrophilia predicts outcome in anal cancer. Radiother Oncol. 2017; 122(1): 137–145.
  11. Tavares-Murta B, Mendonça M, Duarte N, et al. Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer. 2010; 20(7): 1154–1159.
  12. Choi CH, Kang H, Kim WY, et al. Prognostic value of baseline lymphocyte count in cervical carcinoma treated with concurrent chemoradiation. Int J Radiat Oncol Biol Phys. 2008; 71(1): 199–204.
  13. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PLoS One. 2011; 6(9): e25295.
  14. Hasegawa T, Iga T, Takeda D, et al. Neutrophil-lymphocyte ratio associated with poor prognosis in oral cancer: a retrospective study. BMC Cancer. 2020; 20(1): 568.
  15. Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer. 2019; 19(1): 672.
  16. Ethier JL, Desautels D, Templeton A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2017; 19(1): 2.
  17. Kusumanto Y, Dam W, Hospers G, et al. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis. 2003; 6(4): 283–287.
  18. Acmaz G, Aksoy H, Unal D, et al. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev. 2014; 15(4): 1689–1692.
  19. Voutsadakis IA. Thrombocytosis as a prognostic marker in gastrointestinal cancers. World J Gastrointest Oncol. 2014; 6(2): 34–40.
  20. Araneda M, Krishnan V, Hall K, et al. Reactive and clonal thrombocytosis. South Med J. 2001; 94(4): 417–420.
  21. Kaser A, Brandacher G, Steurer W, et al. Interleukin-6 stimulates thrombopoiesis through thrombopoietin: role in inflammatory thrombocytosis. Blood. 2001; 98(9): 2720–2725.
  22. Kishi Y, Kopetz S, Chun YS, et al. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009; 16(3): 614–622.
  23. Fukunaga A, Miyamoto M, Cho Y, et al. CD8+ tumor-infiltrating lymphocytes together with CD4+ tumor-infiltrating lymphocytes and dendritic cells improve the prognosis of patients with pancreatic adenocarcinoma. Pancreas. 2004; 28(1): e26–e31.
  24. Smith RA, Bosonnet L, Ghaneh P, et al. The platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery. 2008; 143(5): 658–666.
  25. Unal D, Eroglu C, Kurtul N, et al. Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non-small cell lung cancer associated with treatment response and prognosis? Asian Pac J Cancer Prev. 2013; 14(9): 5237–5242.
  26. Pergialiotis V, Oikonomou M, Damaskou V, et al. Platelet to lymphocyte and neutrophil to lymphocyte ratio as predictive indices of endometrial carcinoma: Findings from a retrospective series of patients and meta-analysis. J Gynecol Obstet Hum Reprod. 2018; 47(10): 511–516.
  27. Cakmak B, Gulucu S, Aliyev N, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia. Obstet Gynecol Sci. 2015; 58(2): 157–161.
  28. Kurtoglu E, Kokcu A, Celik H, et al. Platelet indices may be useful in discrimination of benign and malign endometrial lesions, and early and advanced stage endometrial cancer. Asian Pac J Cancer Prev. 2015; 16(13): 5397–5400.
  29. Ural ÜM, Şehitoğlu İ, Tekin YB, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res. 2015; 41(3): 445–448.
  30. Dong Y, Cheng Y, Wang J. The ratio of neutrophil to lymphocyte is a predictor in endometrial cancer. Open Life Sci. 2019; 14: 110–118.
  31. Aoyama T, Takano M, Miyamoto M, et al. Pretreatment neutrophil-to-lymphocyte ratio was a predictor of lymph node metastasis in endometrial cancer patients. Oncology. 2019; 96(5): 259–267.