Lymphocyte markers with CA125 and HE4 for diagnosing early endometrial cancer in postmenopausal women: case-control study.

BACKGROUND

Endometrial cancer (EC) is common in postmenopausal women, with early diagnosis critical for prognosis. Traditional tumour markers (CA125, HE4) are limited alone, and the diagnostic value of peripheral blood lymphocyte-related indicators is unclear. This study explored the value of combining these lymphocyte indicators with CA125, HE4 and metabolic factors for early EC diagnosis in postmenopausal women.

METHODS

This is a single-centre case-control study that included 72 postmenopausal women with early EC (FIGO I-II, EC group) and 72 with benign uterine lesions (BL group). Baseline data, immunological markers (lymphocyte count, LYM; lymphocyte-to-monocyte ratio, LMR), CA125 and HE4 were measured. Receiver operating characteristic curves were used to analyse diagnostic performance, and multivariate logistic regression compared model fit.

RESULTS

The EC group had higher rates of diabetes, hypertension and dyslipidaemia (all p < .05), lower LYM and LMR (all p < .01) and higher CA125 and HE4 (all p < .001). Among single markers, HE4 had the highest area under the curve (AUC, 0.725) but low sensitivity (45.8%). The combination of CA125 and HE4 achieved an AUC of 0.759; adding LYM and LMR increased this to0.839. Incorporating metabolic factors further increased the AUC to 0.865 (Akaike information criterion, AIC = 144), which was superior to other models (p < 0.01).

CONCLUSION

Combining lymphocyte indicators (LYM, LMR), CA125, HE4 and metabolic factors significantly improved early EC diagnostic efficacy in postmenopausal women, offering a reliable non-invasive strategy.