The Predictive Role of Neutrophil Percentage-to-Albumin Ratio (NPAR) in Endometrial Carcinoma: A Novel Prognostic Marker

Sıtkı Özbilgeç,1 Fatih Akkuş,2 Emin Erhan Dönmez,3 Mustafa Şahin,1 Pelin Bahçeci,4 Ali Acar4 1Department of Gynecologic Oncology, Konya City Hospital, Konya, Turkey; 2Department of Perinathology, Kütahya City Hospital, Kütahya, Turkey; 3Department of Gynecologic Oncology, Istanbul Training and Research Hospital, Istanbul, Turkey; 4Department of Obstetrics and Gynecology, Necmettin Erbakan University School of Medicine, Konya, TurkeyCorrespondence: Sıtkı Özbilgeç, Email [email protected]: Endometrial carcinoma, EC is the most common gynecologic malignancy in developed countries, and identifying accessible prognostic markers remains critical for guiding treatment strategies. Systemic inflammatory markers have emerged as promising tools in cancer prognosis.Objective: This study aimed to investigate the predictive value of the neutrophil percentage-to-albumin ratio, NPAR in patients diagnosed with endometrial carcinoma and to compare its utility with other systemic inflammatory indices.Methods: This retrospective study included 194 patients who underwent surgical treatment for endometrial carcinoma between January 2020 and May 2025 at a tertiary care center. Preoperative blood samples were used to calculate neutrophil percentage-to-albumin ratio, NPAR, neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, PLR, systemic immune-inflammation index, SII, and other related markers. Patients were analyzed according to final pathological outcomes, and the relationship between inflammatory indices and prognostic parameters such as tumor grade, histologic type, depth of myometrial invasion, lymphovascular space invasion, LVSI and FIGO stage was evaluated. Receiver operating characteristic, ROC analysis was performed to determine optimal cutoff values for NPAR.Results: NPAR did not show a statistically significant association with lymphovascular space invasion (LVSI) or deep myometrial invasion. However, it was significantly associated with advanced stage (FIGO ≥ Stage II). High NPAR, elevated SIRI, high PLR, low NLR, elevated MLR, and increased immature granulocyte count were significant predictors of advanced stage. The regression model demonstrated strong predictive ability for advanced disease (Nagelkerke R² = 0.79; p < 0.001).Conclusion: NPAR is a novel, simple, and cost-effective prognostic biomarker in endometrial carcinoma. Its preoperative evaluation may help identify high-risk patients and contribute to more individualized treatment planning. Further prospective studies are warranted to validate these findings.Keywords: endometrial carcinoma, neutrophil percentage-to-albumin ratio, NPAR, systemic inflammatory markers, pathology, prognostic biomarker