Pretreatment Pan-Immune-Inflammation Value and Corrected Prognostic Nutritional Index for 24-Month Recurrence Risk Stratification After Neoadjuvant Chemotherapy and Surgery in Stage III Endometrial Cancer.

OBJECTIVE

To evaluate pretreatment pan-immune-inflammation value (PIV) and corrected prognostic nutritional index (PNI) as exploratory markers of postoperative 24-month recurrence risk after neoadjuvant chemotherapy (NACT) and interval surgery for stage III endometrial cancer.

METHODS

This retrospective single-center cohort included 362 consecutive women treated from January 2014 through December 2022. Complete blood count and albumin values were obtained within 7 days before the first NACT cycle. The fixed-window analysis included 311 patients with definitive 24-month recurrence status; all 362 patients were retained for recurrence-specific and recurrence/death time-to-event analyses. Internal validation used 100 repetitions of stratified 10-fold cross-validation, nested penalty tuning for comprehensive models, training-fold threshold selection, and 1000 bootstrap resamples for optimism correction.

RESULTS

Among 311 patients with definitive status, 119 (38.3%) had documented recurrence. The PIV-corrected PNI model had a mean repeated-cross-validation AUC of 0.762 and a bootstrap-corrected AUC of 0.763. A penalized comprehensive clinical-pathological-molecular-treatment model had a mean held-out AUC of 0.787; adding PIV and corrected PNI increased it to 0.828 (paired held-out ΔAUC 0.042; bootstrap interval 0.013-0.070). The combined-biomarker model had a repeated-cross-validation calibration slope of 0.828 and intercept of -0.085; its bootstrap-corrected slope and intercept were 0.961 and -0.015. In full-cohort Cox analyses, higher PIV and lower corrected PNI remained associated with documented recurrence and with the composite recurrence/death endpoint. Seventeen deaths without prior documented recurrence were included as composite events, whereas 34 patients censored before 24 months were retained in time-to-event analyses.

CONCLUSION

Pretreatment PIV and corrected PNI provided complementary internally validated prognostic information and improved risk stratification within this cohort. The thresholds and models remain exploratory because model development, calibration, and decision-curve assessment were performed in the same single-center cohort; independent external validation is required before clinical use.