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To identify preoperative platelet indexes with prognostic value and to develop and validate nomograms for predicting the survival of endometrial cancer (EC) patients. A total of 1198 women who received primary surgical treatment between January 2008 and January 2017 were included in the study. Data were randomly divided into a training set (70%, N = 840) and an external validation set (30%, n = 358). Cox regression analysis was performed in the training cohort to identify independent prognostic factors and develop nomograms for survival rate prediction. High platelet count (PLT ≥350), high mean platelet volume (MPV ≥8.8) and low platelet distribution width (PDW <12.1) were independently associated with poor RFS and OS. PLT, MPV and PDW were thus incorporated in an innovative score called the platelet index score (PIS). The PIS was also an independent indicator, which was related to histology, lymph-vascular space invasion, lymph node involvement and FIGO stage (P = 0.007, P = 0.042, P < 0.001 and P < 0.001, respectively). Furthermore, we developed and validated two nomograms based on Cox regression models. The discriminative ability and calibration of the nomograms revealed good predictive ability, as indicated by the C-indexes and calibration plots. Moreover, both the IDI and NRI were improved. Nomograms based on the PIS and clinicopathological features accurately predict recurrence-free survival and overall survival for EC patients. • Endometrial cancer patients with elevated preoperative PLT and MPV and reduced PDW show a worse prognosis. • We present a platelet index score system called the PIS based on PLT, MPV and PDW for prognosis prediction. • Use of these nomograms incorporating the PIS enables individualized counseling and treatment. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to identify coagulation markers with prognostic value in the setting of surgically treated endometrial cancer. Patients and methods: A total of 942 patients with endometrial cancer who underwent surgery were included in the study. The preoperative prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), prothrombin time activity (PTA), fibrinogen and D-dimer values were analyzed to determine their potential associations with clinicopathological characteristics. Survival analysis was performed using the Kaplan-Meier method, p-values were calculated using the log-rank text, and the prognostic factors were evaluated using Cox's proportional hazards regression model. Results: The preoperative plasma fibrinogen and D-dimer concentrations were significantly different among patients with different ages, pre/post-menopausal status, International Federation of Obstetrics and Gynecology Association (FIGO) stage, tumor grade, depth of myometrial invasion, histological type and lymphatic vessel space invasion. Fibrinogen level was also asscoiated with body mass index (BMI) and comorbidities, and D-dimer level was asscoiated with preoperative radiotherapy and chemotherapy. APTT was different in patients in pre/post-menopausal status and with or without comorbidities. PTA was asscoiated with BMI and lymphovascular invasion. TT was different between different age groups, different menopause status groups, as well as different FIGO stage groups. A multivariate analysis identified high fibrinogen levels (>3.25 g/L) as an independent prognostic factor for overall survival (HR=1.807; 95% CI=1.003–3.253; p=0.049). Conclusion: High pretreatment fibrinogen levels are associated with poor overall survival and represent a valuable independent prognostic factor in patients with endometrial cancer. PT, aPTT, TT, PTA and D-dimer levels cannot be used as independent prognostic factors for endometrial cancer. [ABSTRACT FROM AUTHOR]

Naples prognosis score (NPS) is a new immune and nutritional assessment method that can be used to predict tumor prognosis. This study aimed to identify whether NPS is an independent prognostic indicator of operable endometrial cancer (EC). We retrospectively analyzed 1038 patients with endometrial cancer who underwent surgery. Patients were grouped according to NPS (NPS group 0, n = 362; NPS group 1, n = 589; and NPS group 2, n = 87), and differences in clinical characteristics were compared among the groups. Survival analysis was performed by the Kaplan–Meier method, P values were calculated by log–rank test, and prognostic factors were assessed by Cox proportional hazards regression models. Serum albumin levels, total cholesterol levels, neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, total lymphocyte count, CA-125 levels, age, body mass index, FIGO stage, myometrial invasion depth, controlling nutritional status score, and systemic inflammation score were significantly different among the groups; significant differences in progression-free survival(PFS) and overall survival (OS) were also found. On multivariate analysis, NPS was identified as an independent prognostic factor for PFS (NPS group 0 vs. 1: aHR = 4.32, 95%CI = 1.133–16.47; NPS group 0 vs. 2: aHR = 21.336, 95%CI = 3.498–130.121) and OS (NPS group 0 vs. 1: aHR = 5.029, 95%CI = 1.638–15.441; NPS group 0 vs. 2: aHR = 20.789, 95%CI = 4.381–98.664). Moreover, NPS is an independent prognostic factor for PFS and OS in grade 2 or 3 EC (aHR = 7.768, 95%CI = 2.411–25.029 and aHR = 4.717, 95%CI = 1.794–12.407, respectively). High NPS is associated with poor PFS and OS and is a valuable independent prognostic factor in patients with EC. • High Naples prognosis score is associated with poor progression free survival and overall survival in patients with endometrial cancer. • Naples prognosis score is an independent prognostic factor for progression free survival and overall survival in grade 2/3 endometrial cancer. • Naples prognosis score may provide reference of personalized treatment and non-surgical treatment for patients with endometrial cancer. [ABSTRACT FROM AUTHOR]