Fragmented QRS and Neutrophil-to-Lymphocyte Ratio as Noninvasive Biomarkers of Lymphovascular Space Invasion in Endometrial Cancer: A Retrospective Cohort Study

ObjectiveTo evaluate the prognostic significance of fragmentedQRS (fQRS) on electrocardiography and the neutro-phil-to-lymphocyte ratio (NLR) as noninvasive bio-markers in endometrial cancer, with particular focuson their association with lymphovascular space inva-sion (LVSI).Material and MethodIn this retrospective cohort study, 198 patients whounderwent surgery for endometrial cancer were in-cluded. All cases were staged according to the 2023FIGO classification. Preoperative complete bloodcounts and electrocardiograms were assessed to de-termine NLR and the presence of fQRS. Clinicopath-ological variables, including LVSI status, were record-ed and statistically analyzed.ResultsThe median NLR was significantly higher in patientswith fragmented QRS compared with those with-out fragmented QRS (2.45 [1.46–12.42] vs. 2.04[0.66–7.72], p = 0.013). LVSI positivity was observedmore frequently among patients with fQRS (30% vs.11.3%, p = 0.007). ROC curve analysis identified anoptimal NLR cut-off value of 2.4 for predicting substan-tial 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 demonstrat-ed 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 withthe presence of fragmented QRS.ConclusionBoth fQRS and NLR were associated with LVSI in pa-tients with endometrial cancer and may reflect adversepathological features related to tumor aggressiveness.However, these findings should be considered explor-atory, and further prospective studies are required be-fore clinical implementation can be recommended.