Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer

• Monocyte counts obtained prior to hysterectomy-based surgical staging were correlated to tumor characteristics and survival of patients with endometrial cancer.
• Elevated monocyte counts were associated with aggressive tumor behavior including deep myometrial tumor invasion, lymph node metastasis, and advanced stage.
• Elevated monocyte counts were an independent prognostic factor for decreased survival outcome of endometrial cancer patients.

ObjectiveTumor-associated macrophages are known to be associated with decreased survival of patients with endometrial cancer. Given the physiological link of circulating monocytes as a progenitor of tumor-associated macrophages, monocyte counts were examined for tumor characteristics and survival in endometrial cancer.MethodsA retrospective study was conducted to examine consecutive patients with endometrial cancer with all histologic types who underwent hysterectomy-based surgical staging between 2003 and 2013 (n = 541). Preoperative monocyte counts were correlated to patient demographics, pathological findings, complete blood count results, and survival outcomes.ResultsMedian monocyte counts were 0.5 × 109/L. Monocyte counts significantly correlated with all other complete blood count components, with neutrophil counts having the most significant association (r = 0.52, p < 0.001). Elevated monocyte counts (defined as > 0.7 × 109/L) when compared to lower counts were significantly associated with an increased risk of > 50% myometrial tumor invasion (29.2% versus 22.0%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.01–2.45, p = 0.045), pelvic lymph node metastasis (39.0% versus 18.8%, OR 2.76, 95%CI 1.35–5.62, p = 0.007), and advanced-stage (stage I through IV, 18.5%, 24.6%, 32.5%, and 41.5%, p = 0.001). In survival analysis, elevated monocyte counts were associated with decreased disease-free survival (5-year rates, 71.0% versus 84.5%, p = 0.001) and overall survival (77.2% versus 89.3%, p < 0.001). In multivariate analysis, elevated monocyte counts remained an independent prognostic factor for decreased disease-free (hazard ratio [HR] 1.74, 95% CI 1.02–2.96, p = 0.041) and overall (HR 2.63, 95% CI 1.37–5.05, p = 0.004) survival.ConclusionsElevated monocyte counts were associated with aggressive tumor features and poor survival outcomes of patients with endometrial cancer.