{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:04:13Z","timestamp":1785301453039,"version":"3.55.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preoperative assessment of lymph node metastasis (LNM) risk is critical for surgical planning in endometrial cancer (EC). Transvaginal ultrasound (TVU) endometrial thickness (ET) is a routinely available morphological parameter, whereas nutritional and metabolic indicators reflect the systemic host-tumor interaction. Although prior studies have incorporated either imaging or biomarker-based predictors individually, a unified preoperative framework integrating TVU morphology with a comprehensive panel of nutritional, inflammatory, and metabolic biomarkers for LNM prediction has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study enrolled 203 patients with histopathologically confirmed EC who underwent definitive surgical staging at our institution between January 2021 and December 2025. Preoperative TVU-measured ET, tumor size, depth of myometrial invasion (MI), and cervical stromal invasion were recorded, alongside nutritional, inflammatory, and metabolic biomarkers including CA-125, HE4, albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), fibrinogen, fasting blood glucose, and triglyceride-glucose (TyG) index. Spearman correlation analysis quantified associations between ET and biomarkers. Univariate and multivariate logistic regression identified independent LNM predictors. Receiver operating characteristic (ROC) curve analysis with DeLong tests evaluated discriminative performance, and a nomogram was constructed and internally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LNM was confirmed in 35 patients (17.2%). ET was significantly higher in LNM-positive patients (34.7\u202f\u00b1\u202f11.6\u202fmm vs. 22.4\u202f\u00b1\u202f8.1\u202fmm,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and demonstrated moderate-to-strong positive correlations with CA-125 (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.512), HE4 (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.468), NLR (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.398), fibrinogen (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.426), and TyG index (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.233), and negative correlations with albumin (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f\u22120.374) and PNI (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f\u22120.441) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Multivariate analysis identified ET (adjusted OR\u202f=\u202f1.092 per mm, 95% CI: 1.043\u20131.143), deep MI\u202f\u2265\u202f50% (OR\u202f=\u202f4.827), CA-125\u202f\u2265\u202f35\u202fU\/mL (OR\u202f=\u202f3.614), NLR\u202f\u2265\u202f3.0 (OR\u202f=\u202f3.082), PNI\u202f&amp;lt;\u202f50 (OR\u202f=\u202f2.947), fibrinogen \u22654.0\u202fg\/L (OR\u202f=\u202f2.614), grade 3 histology (OR\u202f=\u202f3.408), and non-endometrioid type (OR\u202f=\u202f2.891) as independent predictors of LNM (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). The combined nomogram achieved an AUC of 0.941 (95% CI: 0.895\u20130.987), significantly outperforming ET alone (AUC\u202f=\u202f0.812,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative TVU-ET is significantly correlated with nutritional, inflammatory, and metabolic indicators and independently predicts LNM in EC. A nomogram integrating ET with CA-125, NLR, PNI, fibrinogen, tumor grade, and histological type provides promising, good internally validated discrimination for LNM and may guide individualized surgical planning. External validation in independent cohorts remains necessary before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1900875","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:49:55Z","timestamp":1785300595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A preoperative nomogram integrating transvaginal ultrasound endometrial thickness and nutritional, inflammatory, and metabolic indicators for predicting lymph node metastasis in endometrial cancer"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaodi","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Ultrasound, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital)","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Pediatrics, No. 965 Hospital of the PLA Joint Logistics Support Force","place":["Jilin City, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gongxue","family":"Xian","sequence":"additional","affiliation":[{"name":"Department of Outpatient, The General Hospital of Western Theater Command of Chinese People's Liberation Army","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital)","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.ygyno.2021.01.036","article-title":"Variations in incidence and mortality rates of endometrial cancer at the global, regional, and national levels, 1990-2019","volume":"161","author":"Gu","year":"2021","journal-title":"Gynecol Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.3390\/diagnostics11081472","article-title":"Ultrasound measurement of tumor-free distance from the Serosal surface as the alternative to measuring the depth of myometrial invasion in predicting lymph node metastases in endometrial Cancer","volume":"11","author":"Liro","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1446850","DOI":"10.3389\/fonc.2025.1446850","article-title":"Ultrasound in endometrial cancer: evaluating the impact of pre-surgical staging","volume":"15","author":"Rei","year":"2025","journal-title":"Front Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4499","DOI":"10.1016\/j.acra.2024.07.056","article-title":"Prediction of lymph node metastasis in endometrial cancer based on color doppler ultrasound radiomics","volume":"31","author":"Liu","year":"2024","journal-title":"Acad Radiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"907","DOI":"10.3390\/cancers16050907","article-title":"Diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging for the detection of myometrial infiltration in endometrial cancer: a systematic review and meta-analysis","volume":"16","author":"Mad\u00e1r","year":"2024","journal-title":"Cancers (Basel)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"762329","DOI":"10.3389\/fonc.2021.762329","article-title":"Association of myometrial invasion with lymphovascular space invasion, lymph node metastasis, recurrence, and overall survival in endometrial cancer: a meta-analysis of 79 studies with 68,870 patients","volume":"11","author":"Wang","year":"2021","journal-title":"Front Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7131","DOI":"10.2147\/JIR.S345790","article-title":"Systemic immune-inflammatory index as a predictor of lymph node metastasis in endometrial Cancer","volume":"14","author":"Lei","year":"2021","journal-title":"J Inflamm Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1159\/000527941","article-title":"The utility of preoperative serum CA125 combined with HE4 to predict lymph node metastasis in endometrial cancer","volume":"88","author":"Prueksaritanond","year":"2023","journal-title":"Gynecol Obstet Investig"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"15654","DOI":"10.3390\/ijerph192315654","article-title":"Development and validation of a nomogram based on metabolic risk score for assessing Lymphovascular space invasion in patients with endometrial Cancer","volume":"19","author":"Wang","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1472892","DOI":"10.3389\/fonc.2024.1472892","article-title":"Preoperative prediction of lymph node metastasis in endometrial cancer patients via an intratumoral and peritumoral multiparameter MRI radiomics nomogram","volume":"14","author":"Yan","year":"2024","journal-title":"Front Oncol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.7150\/ijms.96179","article-title":"A metabolic-inflammatory-nutritional score (MINS) is 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setting","volume":"12","author":"LyBarger","year":"2022","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"169","DOI":"10.7150\/ijms.87752","article-title":"Nutritional index in relation to prognosis of endometrial cancer","volume":"21","author":"Gen","year":"2024","journal-title":"Int J Med Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e35211","DOI":"10.1016\/j.heliyon.2024.e35211","article-title":"Prognostic and clinicopathological role of prognostic nutritional index (PNI) in endometrial cancer: a meta-analysis","volume":"10","author":"Mao","year":"2024","journal-title":"Heliyon"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e163","DOI":"10.3346\/jkms.2023.38.e163","article-title":"Preoperative prognostic nutritional index is a prognostic indicator of cancer-specific survival in patients undergoing endometrial cancer surgery","volume":"38","author":"Kim","year":"2023","journal-title":"J Korean Med Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"5632","DOI":"10.3390\/cancers14225632","article-title":"Nomograms based on fibrinogen, albumin, neutrophil-lymphocyte ratio, and carbohydrate antigen 125 for predicting endometrial Cancer prognosis","volume":"14","author":"Li","year":"2022","journal-title":"Cancers (Basel)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1007\/s13193-025-02228-5","article-title":"Additional risk factors lead to a measurable inflammatory response in stage I endometrial cancer\u2014a prospective multicentric observational study","volume":"16","author":"Ronsini","year":"2025","journal-title":"Indian J Surg Oncol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"56\u201360","DOI":"10.1016\/j.cancergen.2024.12.004","article-title":"Machine learning analysis of CD4 + T cell gene expression in diverse diseases: insights from cancer, metabolic, respiratory, and digestive disorders","author":"Liao","year":"2025","journal-title":"Cancer Genet."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1002\/ijgo.15108","article-title":"Triglyceride-glucose index (TyG index) and endometrial carcinoma risk: a retrospective cohort study","volume":"164","author":"Shi","year":"2024","journal-title":"Int J Gynaecol Obstet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1351982","DOI":"10.3389\/fendo.2024.1351982","article-title":"Association between metabolic disorders and clinicopathologic features in endometrial cancer","volume":"15","author":"Wang","year":"2024","journal-title":"Front Endocrinol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1136\/ijgc-2020-002230","article-title":"ESGO\/ESTRO\/ESP guidelines for the management of patients with endometrial carcinoma","volume":"31","author":"Concin","year":"2021","journal-title":"Int J Gynecol 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Genet"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.cancergen.2025.07.014","article-title":"Pan-cancer methylation analysis of circulating cell-free DNA","author":"Dong","year":"2025","journal-title":"Cancer Genet"}],"container-title":["Frontiers in Public 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