Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Dong Soo Suh,1,2,&ast; Yong Jung Song,1,2,&ast; Hyun-Jin Roh,3 Sang Hun Lee,3 Dae Hoon Jeong,4 Tae Hwa Lee,5 Kyung Un Choi,6 Ki Hyung Kim1,2 1Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, South Korea; 2Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea; 3Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea; 4Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; 5Department of Obstetrics and Gynecology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; 6Department of Pathology, Pusan National University School of Medicine, Busan, South Korea&ast;These authors contributed equally to this workCorrespondence: Ki Hyung KimDepartment of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, South KoreaTel +82-51-240-7287Fax +82-51-248-2384Email ghkim@pusan.ac.krPurpose: Preoperative diagnosis of uterine leiomyosarcoma (LMS) is challenging because the disease can mimic benign leiomyoma (LM). The objective of the present study was to investigate the role of preoperative clinical characteristics and hematologic parameters to differentiate uterine LMS and LM.Methods: Preoperative clinical and laboratory variables were reviewed retrospectively in patients with LMS or LM, and the significances of intergroup differences were assessed. Receiver operating characteristic (ROC) curves were used to determine optimal cut-off values for each variable. Logistic regression analysis was applied to identify variables predicting the presence of LMS.Results: The preoperative clinical and laboratory variables of 336 patients with uterine tumor were analyzed. Seventy-nine patients had LMS and 257 had LM. A significant difference was observed between LMS and LM in terms of the median value of age at diagnosis, menopausal status, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), lactate dehydrogenase (LDH), and neutrophil-to-lymphocyte ratio (NLR) (all P < 0.001). Multivariate analyses showed that menopausal status (odds ratio [OR] = 3.40, P= 0.002), WBC count (OR = 2.09, P = 0.012), ANC (OR = 3.17, P < 0.001), CRP (OR = 21.74, P < 0.001), LDH (OR = 10.77, P < 0.001), and NLR (OR = 2.58, P = 0.001) predicted the presence of LMS.Conclusion: Our results suggest that in older or postmenopausal patients, high WBC count, ANC, CRP, LDH, and NLR could be useful biomarkers for the differentiation of LMS and LM, which indicate that serum markers might be useful, cost-effective, and broadly available diagnostic markers for uterine LMS.Keywords: C-reactive protein, lactate dehydrogenase, leiomyoma, leiomyosarcoma, neutrophil-to-lymphocyte ratio