Yao Xiao,1,* Yunfeng Zheng,2,3,* Yuan Tu,2 Chenfan Tian,2 Jiaxin Yu,2 Honggui Lin,4 Tian Wen,4 Peng Jiang,2 Yifeng Wang1 

1Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China; 2Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 3Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University; Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Hangzhou, Zhejiang, People’s Republic of China; 4The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510280, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yifeng Wang, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China, Tel +86 023-68486646, Email wangyfsmu@163.com Peng Jiang, Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China, Tel +86 023-68811360, Email 1094496466@qq.com

Background: This study evaluated the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score for postoperative recurrence in endometrial cancer patients. A nomogram was developed based on clinicopathological parameters, HALP score, and immunohistochemical markers to predict recurrence-free survival (RFS) in patients with stage I–III endometrial cancer.
Methods: This retrospective study included 1,083 patients who underwent hysterectomy at the First Affiliated Hospital of Chongqing Medical University from January 2013 to January 2021. Independent risk factors for RFS were identified using univariate and multivariate Cox regression analyses, and a nomogram was established. External validation was performed with data from Zhujiang Hospital of Southern Medical University and Women and Children’s Hospital of Chongqing Medical University (n = 677).
Results: Among the entire cohort, 241 cases (13.7%) of endometrial cancer experienced recurrence post-hysterectomy. The median RFS time was 47.0 (range: 6.0– 91.0) months. Eleven independent prognostic factors were identified, including age, FIGO staging, histologic type, myometrial invasion, lymphovascular space invasion, Ca125, Ki-67 expression, ER expression, molecular classification, adjuvant therapy, and HALP score, and then a nomogram for predicting recurrence of endometrial cancer was established. The nomogram demonstrated improved predictive accuracy, categorizing patients into high- and low-risk groups. High-risk patients receiving adjuvant treatment had better outcomes than those who did not.
Conclusion: We developed and validated a nomogram to predict recurrence in endometrial cancer patients. Integrating the HALP score can help clinicians identify high-risk patients and tailor personalized treatment strategies.

Keywords: endometrial cancer, prognosis, nomogram, HALP scores, adjuvant therapy, molecular classification