ESTRO 2025 - Abstract Book

S881

Clinical - Gynaecology

ESTRO 2025

4333

Poster Discussion Impact of systemic inflammatory parameters and immuno-nutritional indices on endometrial cancer survival: A prospective database analysis. Kelechi Njoku 1 , Neal C Ramchander 2 , Louise Y Wan 3 , Chloe E Barr 4 , Emma J Crosbie 5 1 Christie NHS Foundation Trust, University of Manchester, Manchester, United Kingdom. 2 Division of Cancer Sciences, CRUK Beatson Centre, Scotland, United Kingdom. 3 Department of Gynaeoncology, Liverpool Womens NHS Foundation Trust, Liverpool, United Kingdom. 4 Department of Gynaeoncology, Gatehead NHS Foundation Trust, Newcastle, United Kingdom. 5 Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom Purpose/Objective: Although most women with endometrial cancer are diagnosed with disease that is amenable to curative surgical resection, a significant minority present with advanced or metastatic disease and face a dismal prognosis. Identifying factors that influence survival is crucial to mitigating the impact of the rising disease burden. Inflammation predisposes to tumorigenesis by damaging DNA, stimulating angiogenesis and potentiating pro proliferative and anti-apoptotic processes. Cancer-associated malnutrition is commonly associated with a deceased immune function and predisposes to increased post-operative morbidity and mortality. The aim of this study was to investigate whether pre-treatment biomarkers of systemic inflammation and immuno nutritional status are associated with survival outcomes in endometrial cancer. Material/Methods: Women with endometrial cancer were recruited to a prospective database study. Pre-treatment systemic markers of inflammation and immuno-nutritional indices, including C-reactive protein (CRP), Glasgow Prognostic Score, lymphocyte-based ratios [neutrophil-lymphocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII)], and the Prognostic Nutritional Index (PNI) were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox regression. Results: In total, 522 women of mostly White British ethnicity, with a median age of 66 years (interquartile range (IQR), 56, 73) and BMI of 32 kg/m 2 (IQR 26, 39) were included in the analysis. Most had low-grade (67.2%), early-stage (85.4% stage I/II), endometrioid (74.5%) tumors. Women with pre-treatment CRP ≥5.5 mg/L had a 68% increase in overall (adjusted HR = 1.68, 95% CI 1.00-2.81, p = 0.049) and a two-fold higher cancer-specific mortality risk than those with CRP <5.5 mg/L (adjusted HR = 2.04, 95%CI 1.03-4.02, p = 0.04). Women with pre-treatment PNI ≥45 had a 45% decrease in both overall (adjusted HR = 0.55, 95% CI 0.33–0.92, p = 0.022) and cancer-specific mortality risk (adjusted HR = 0.55, 95%CI 0.30–0.99, p = 0.048) compared to those with PNI <45. There was no evidence for an effect of PNI on recurrence free survival. Absolute lymphocyte count, NLR, MLR and SII were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. Conclusion: If confirmed in an independent cohort, CRP and PNI may offer simple, low-cost tests to refine pre-treatment risk assessment and guide personalised care in endometrial cancer. Our participants were mostly of White British ethnicity and further studies are needed to confirm the utility of CRP and PNI as prognostic biomarkers in other populations.

Keywords: endometrial cancer, inflammation, survival