Work

Integrating Systemic Inflammation, Nutrition and Skeletal Muscle into a Composite Score (the HALP–Sarcopenia Combined Index) for Preoperative Risk Stratification of Lymph-Node Metastasis and Recurrence in Endometrial Carcinoma: A Single-Centre Retrospective Study

Year: 2026

Type: article

Abstract: Background: Lymph-node metastasis and recurrence dominate outcomes in endometrial carcinoma, yet the strongest predictors are recovered only from the hysterectomy specimen, whereas systemic inflammation, nutritional reserve and skeletal-muscle mass are measurable before surgery. We investigated whether a preoperatively obtainable composite-the HALP-Sarcopenia Combined Index (HS-index)-is associated with nodal metastasis and recurrence. Methods: We retrospectively studied 195 consecutive women undergoing primary surgery for endometrial carcinoma. The HS-index was specified a priori from the standardised HALP score and skeletal-muscle index (SMI). Nodal metastasis, assessable in the 181 women who underwent lymph-node evaluation, was modelled with logistic regression; recurrence was modelled with Cox proportional-hazards regression. Restricted cubic splines, decision-curve analysis and bootstrap-validated C-statistics were used to characterise the shape and clinical usefulness of the associations. Results: Nodal metastasis occurred in 30 of 181 women (16.6%) and recurrence in 43 of 195 (22.1%; median follow-up 34 months). Per standard deviation, a higher HS-index was independently associated with lower odds of nodal metastasis (adjusted odds ratio 0.48, 95% CI 0.27-0.85; P = 0.012) and a lower hazard of recurrence (adjusted hazard ratio 0.37, 95% CI 0.25-0.55; P < 0.001) after adjustment for grade, myometrial invasion, lymphovascular space invasion, histological type and adjuvant therapy. Adding the HS-index to a clinicopathological model raised the area under the curve from 0.853 to 0.870, a non-significant increment. Conclusions: A preoperatively available composite of nutrition, inflammation and muscle mass was independently and monotonically associated with nodal metastasis and recurrence. It is best positioned as an exploratory adjunct to, not a substitute for, surgical-pathologic staging, and requires external validation before clinical use.

Source: International Journal of Women s Health

DOI: 10.2147/ijwh.s647101

Authors: Qingqing Zhang, Danfeng Guo, Dan Li

Institutions: Soochow University, Wuxi Ninth People's Hospital, Jiangnan University

Language: English

Topic: Endometrial and Cervical Cancer Treatments

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836