Akademik Veri Yönetim Sistemi
Medicine, cilt.104, sa.39, 2025 (SCI-Expanded, Scopus)
This study aimed to evaluate the association between noninvasive liver fibrosis and steatosis scores (including the aspartate transaminase to alanine transaminase ratio to platelet ratio index, aspartate transaminase-platelet ratio index [APRI], Fibrosis-4 index, modified Fibrosis-4 index [mFIB-4], and hepatic steatosis index) as well as ultrasonographic steatosis scores (USS), with histopathological features of endometrioid-type endometrial cancer (EC) and their potential impact on survival outcomes. This retrospective observational study included 415 patients diagnosed with endometrioid-type EC who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Preoperative metabolic scores, including aspartate transaminase to alanine transaminase ratio to platelet ratio index, APRI, Fibrosis-4 index, mFIB-4, and hepatic steatosis index, were calculated from blood samples. USS and the diagnosis of metabolic dysfunction-associated fatty liver disease were based on liver imaging and metabolic criteria. Disease-free survival and overall survival were analyzed; significance was set at P < .05. Analysis showed that patients with body mass index <30 kg/m2 had higher rates of deep myometrial invasion (44.8% vs 27.3%, P = .014), serosal invasion (6.9% vs 0.6%, P = .017), lympho-vascular space invasion (34.5% vs 15.8%, P = .002), and MSH6 loss (9.8% vs 1.4%, P = .014) compared to obese patients. USS correlated with age, myometrial invasion depth, and PMS2 loss. Myometrial invasion >1/2 was more frequent in patients with mFIB-4 > 0.19 (37.5% vs 29%, P = .048). Lower APRI (≤0.19) was related to the higher rate of cervical stromal invasion (15.8% vs 9.1%, P = .027), lympho-vascular space invasion (29.7% vs 17.7%, P = .002), adnexal involvement (11.3% vs 5.6%, P = .026), and lymph node metastasis (24.1% vs 12.8%, P = .009). Multivariable analysis showed advanced stage (HR = 5.172, P < .001) and presence of at least one mismatch repair gene defect (HR = 2.936, P = .011) independently predicted poor disease-free survival. Advanced stage (HR = 7.519, P < .001) and a high mFIB-4 score (HR = 2.281, P = .020) independently predicted worse overall survival. In conclusion, advanced stage remains the most significant independent predictor of poor oncological outcomes in endometrioid-type EC. Furthermore, this study highlights the prognostic relevance of metabolic dysfunction in this patient group. Noninvasive liver fibrosis markers (particularly mFIB-4 and APRI) were significantly associated with adverse histopathological features and survival outcomes, suggesting their potential role in risk stratification and prognosis assessment in endometrioid-type EC.