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 Retros

Qingqing Zhang,1,* Danfeng Guo,2,* Dan Li21Department of Medical Record Room, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214000, People’s Republic of China; 2Department of Gynaecology, Wuxi Maternity and Child Health Care Hospital (Affiliated Women’s Hospital of Jiangnan University), Wuxi City, Jiangsu Province, 214000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dan Li, Department of Gynaecology, Wuxi Maternity and Child Health Care Hospital, No. 48, Samuel Lane, Liangxi District, Wuxi City, Jiangsu Province, 214000, People’s Republic of China, Email [email protected]: 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.Keywords: endometrial carcinoma, HALP score, sarcopenia, skeletal-muscle index, lymph-node metastasis, disease-free survival