{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:01:33Z","timestamp":1792800093322,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"publisher","award":["TCMF-P 111-01"],"award-info":[{"award-number":["TCMF-P 111-01"]}],"id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>This retrospective cohort study aimed to evaluate the factors related to endometrial cancer (EC) prognosis and survival in eastern Taiwan. The study involved 48 patients diagnosed with EC who underwent hysterectomy-based surgery at Hualien Tzu Chi hospital between January 2011 and June 2021. The patients\u2019 medical history and laboratory examination results were reviewed. Progression-free survival and overall survival were determined. Categorical variables were analyzed using the chi-square test, and continuous variables were analyzed using the independent t-test. The receiver operating characteristic curve was used to predict diagnostic value. Factors associated with cancer mortality were identified via Cox regression analysis (p &lt; 0.05). Patients were divided into the death (n = 7) and survival (n = 41) groups. The median age of the patients was 56 years (range: 31\u201371 years). The median observation period was 33.29 months. Diabetes mellitus (DM) and monocyte\/lymphocyte ratio (MLR) &gt; 0.23886 were significantly associated with cancer mortality (p = 0.024 and p = 0.028, respectively). MLR-low and MLR-high groups exhibited 5-year overall survival rates of 96% and 60%, respectively, and 5-year progression-free survival rates of 96% and 41%, respectively. DM and MLR of &gt;0.2386 were suggested to be associated with cancer death, poor overall survival, and progression-free survival.<\/jats:p>","DOI":"10.3390\/diagnostics13010044","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:45:54Z","timestamp":1672116354000},"page":"44","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Association between Diabetes Mellitus, High Monocyte\/Lymphocyte Ratio, and Survival in Endometrial Cancer: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Ruo-Shi","family":"Bing","sequence":"first","affiliation":[{"name":"Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City 23106, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing Lam","family":"Tsui","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5105-068X","authenticated-orcid":false,"given":"Dah-Ching","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Tzu Chi University, Hualien 970, Taiwan"},{"name":"Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1001\/jamainternmed.2018.2820","article-title":"Association of endometrial cancer risk with postmenopausal bleeding in women: A systematic review and meta-analysis","volume":"178","author":"Clarke","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/S0140-6736(15)00130-0","article-title":"Endometrial cancer","volume":"387","author":"Morice","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5468\/ogs.2014.57.1.1","article-title":"Surgical treatment for apparent early stage endometrial cancer","volume":"57","author":"Sonoda","year":"2014","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1634\/theoncologist.2016-0062","article-title":"Chemotherapy for endometrial cancer in adjuvant and advanced disease settings","volume":"21","author":"Bestvina","year":"2016","journal-title":"Oncologist"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.21037\/tcr.2019.05.03","article-title":"Adjuvant therapy of endometrial cancer: \u201cTaxane or not taxane, this is the question\u201d","volume":"8","author":"Lorusso","year":"2019","journal-title":"Transl. Cancer Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6697","DOI":"10.1038\/s41598-019-43261-z","article-title":"Estrogen-related receptor alpha induces epithelial-mesenchymal transition through cancer-stromal interactions in endometrial cancer","volume":"9","author":"Yoriki","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kasius, J.C., Pijnenborg, J.M.A., Lindemann, K., Forsse, D., van Zwol, J., Kristensen, G.B., Krakstad, C., Werner, H.M.J., and Amant, F. (2021). Risk stratification of endometrial cancer patients: FIGO stage, biomarkers and molecular classification. Cancers, 13.","DOI":"10.3390\/cancers13225848"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.brachy.2018.08.002","article-title":"Does postoperative irradiation improve survival in early-stage endometrial cancer?","volume":"17","author":"Sabater","year":"2018","journal-title":"Brachytherapy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1817339","DOI":"10.1155\/2022\/1817339","article-title":"Significance of TP53 mutational status-associated signature in the progression and prognosis of endometrial carcinoma","volume":"2022","author":"Chen","year":"2022","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1111\/jog.15356","article-title":"Prognostic values of human epididymis Protein 4 expression in patients with endometrial cancer: A systematic review and meta-analysis","volume":"48","author":"Han","year":"2022","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4639","DOI":"10.3748\/wjg.v26.i31.4639","article-title":"Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients","volume":"26","author":"Jakubowska","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13048-019-0527-z","article-title":"Prognostic value of lymphocyte-to-monocyte ratio in ovarian cancer: A meta-analysis","volume":"12","author":"Gong","year":"2019","journal-title":"J. Ovarian Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3407","DOI":"10.7150\/jca.50552","article-title":"Prognostic value of peripheral blood lymphocyte\/monocyte ratio in lymphoma","volume":"12","author":"Gao","year":"2021","journal-title":"J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"538","DOI":"10.7150\/jca.14206","article-title":"The lymphocyte-monocyte ratio predicts patient survival and aggressiveness of endometrial cancer","volume":"7","author":"Eo","year":"2016","journal-title":"J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"899262","DOI":"10.3389\/fonc.2022.899262","article-title":"Impact of type 2 diabetes mellitus on endometrial cancer survival: A prospective database analysis","volume":"12","author":"Njoku","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Gawi\u0144ski, C., Michalski, W., Mr\u00f3z, A., and Wyrwicz, L. (2022). Correlation between lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and tumor-infiltrating lymphocytes (TILs) in left-sided colorectal cancer patients. Biology, 11.","DOI":"10.21203\/rs.3.rs-1243808\/v1"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"575809","DOI":"10.3389\/fneur.2020.575809","article-title":"High monocyte-to-lymphocyte ratio is associated with stroke-associated pneumonia","volume":"11","author":"Cheng","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1515\/cclm-2014-0447","article-title":"The lymphocyte to monocyte ratio in peripheral blood represents a novel prognostic marker in patients with pancreatic cancer","volume":"53","author":"Stotz","year":"2015","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1111\/jcmm.17214","article-title":"Lymphocyte percentage as a valuable predictor of prognosis in lung cancer","volume":"26","author":"Huang","year":"2022","journal-title":"J. Cell. Mol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3389\/fimmu.2018.00101","article-title":"Regulation of CD8+ T cells and antitumor immunity by Notch signaling","volume":"9","author":"Tsukumo","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"194","DOI":"10.3389\/fimmu.2017.00194","article-title":"CD4 CTL, a cytotoxic subset of CD4+ T cells, their differentiation and function","volume":"8","author":"Takeuchi","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_22","unstructured":"Coico, R. (2021). Immunology: A Short Course, John Wiley & Sons."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1126\/science.1178331","article-title":"Development of monocytes, macrophages, and dendritic cells","volume":"327","author":"Geissmann","year":"2010","journal-title":"Science"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1016\/j.apsb.2020.04.004","article-title":"The role of tumor-associated macrophages (TAMs) in tumor progression and relevant advance in targeted therapy","volume":"10","author":"Yang","year":"2020","journal-title":"Acta Pharm. Sin. B"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cong, R., Kong, F., Ma, J., Li, Q., Wu, Q., and Ma, X. (2020). Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: A superior prognostic factor of endometrial cancer. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-06953-8"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3712","DOI":"10.7150\/ijms.64658","article-title":"Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer","volume":"18","author":"Song","year":"2021","journal-title":"Int. J. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Holub, K., Busato, F., Gouy, S., Sun, R., Pautier, P., Genestie, C., Morice, P., Leary, A., Deutsch, E., and Haie-Meder, C. (2020). Analysis of systemic inflammatory factors and survival outcomes in endometrial cancer patients staged I-III FIGO and treated with postoperative external radiotherapy. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051441"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"734948","DOI":"10.3389\/fonc.2022.734948","article-title":"Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, or monocyte-to-lymphocyte ratio in endometrial neoplasms: A systematic review and meta-analysis","volume":"12","author":"Leng","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1038\/bjc.2014.407","article-title":"Association between diabetes, diabetes treatment and risk of developing endometrial cancer","volume":"111","author":"Luo","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chu, D., Wu, J., Wang, K., Zhao, M., Wang, C., Li, L., and Guo, R. (2018). Effect of Metformin Use on the Risk and Prognosis of Endometrial Cancer: A Systematic Review and Meta-Analysis. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4334-5"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.3389\/fonc.2020.00269","article-title":"Nomograms for predicting cancer-specific and overall survival among patients with endometrial carcinoma: A SEER based study","volume":"10","author":"Zhu","year":"2020","journal-title":"Front. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/1\/44\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:16Z","timestamp":1760147356000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/1\/44"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["diagnostics13010044"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13010044","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,23]]}}}