Clinicopathological and preoperative biomarkers associated with recurrence after primary surgical treatment for endometrial cancer.

BACKGROUND: Postoperative recurrence remains a major concern in endometrial cancer (EC), and routinely available preoperative biomarkers may complement established clinicopathological factors. This study aimed to evaluate the associations of preoperative neutrophil-to-lymphocyte ratio (NLR), fibrinogen (FIB), and serum cancer antigen 125 (CA125) with recurrence after primary surgical treatment for EC. METHODS: This single-center retrospective cohort included 368 patients treated between January 2019 and December 2024. Cohort-specific biomarker thresholds were derived by receiver operating characteristic analysis using the maximum Youden index. Multivariable logistic regression evaluated associations with recurrence after adjustment for International Federation of Gynecology and Obstetrics (FIGO) stage, histological type, and myometrial invasion. Sensitivity analyses, recurrence-free survival analysis, Firth penalized regression, and bootstrap internal validation were also performed. RESULTS: During a median follow-up of 30 months, 32 patients (8.7%) experienced recurrence. Recurrence was associated with NLR >2.16 (odds ratio [OR], 4.03; 95% confidence interval [CI], 1.40-11.63), FIB >3.38 g/L (OR, 3.55; 95% CI, 1.30-9.67), CA125 >18.06 U/mL (OR, 2.52; 95% CI, 1.25-5.07), FIGO stage III disease (OR, 3.73; 95% CI, 1.45-9.59), non-adenocarcinoma histology (OR, 3.28; 95% CI, 1.35-7.96), and myometrial invasion ≥1/2 (OR, 3.01; 95% CI, 1.30-6.96). After Bonferroni correction, only FIGO stage III remained significant, whereas all six variables met the Benjamini-Hochberg false discovery rate threshold. The areas under the curve were 0.714 for NLR, 0.658 for FIB, and 0.765 for CA125. The optimism-corrected C-statistic was 0.835. CONCLUSION: Preoperative NLR, FIB, and CA125 were associated with postoperative recurrence and may provide complementary information to clinicopathological factors. The cohort-specific thresholds require external validation in larger multicenter studies before clinical application.