Candost HANEDAN, Hande Nur ÖNCÜ, Nurullah ÇETİN, Çağanay SOYSAL, Vakkas KORKMAZ
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi - 2026;33(3):327-335
Objective: To evaluate the prognostic significance of fragmented QRS (fQRS) on electrocardiography and the neutrophil-to-lymphocyte ratio (NLR) as noninvasive biomarkers in endometrial cancer, with particular focus on their association with lymphovascular space invasion (LVSI). Material and Method: In this retrospective cohort study, 198 patients who underwent surgery for endometrial cancer were included. All cases were staged according to the 2023 FIGO classification. Preoperative complete blood counts and electrocardiograms were assessed to determine NLR and the presence of fQRS. Clinicopathological variables, including LVSI status, were recorded and statistically analyzed. Results: The median NLR was significantly higher in patients with fragmented QRS compared with those without fragmented QRS (2.45 [1.46-12.42] vs. 2.04 [0.66-7.72], p = 0.013). LVSI positivity was observed more frequently among patients with fQRS (30% vs. 11.3%, p = 0.007). ROC curve analysis identified an optimal NLR cut-off value of 2.4 for predicting substantial LVSI (AUC = 0.62, 95 % CI: 0.55-0.69, p = 0.013), with a sensitivity of 64.3% and specificity of 58.2%. Multivariable logistic regression analysis demonstrated that higher BMI (OR: 1.07, 95% CI: 1.01-1.14, p = 0.031), smoking (OR: 2.84, 95% CI: 1.18-6.84, p = 0.020), hypertension (OR: 0.38, 95% CI: 0.15-0.96, p = 0.041), and LVSI positivity (OR: 3.21, 95% CI: 1.24-8.31, p = 0.016) were independently associated with the presence of fragmented QRS. Conclusion: Both fQRS and NLR were associated with LVSI in patients with endometrial cancer and may reflect adverse pathological features related to tumor aggressiveness. However, these findings should be considered exploratory, and further prospective studies are required before clinical implementation can be recommended.
