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A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma

  • Authors:
    • Yunyun Chen
    • Jianwei Li
    • Li Yan
    • Peili Liu
    • Fanfei Meng
    • Yajun Zhang
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    Affiliations: Department of Pathology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu 222006, P.R. China, Department of Gynaecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu 222006, P.R. China, Department of Pathology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu 222006, P.R. China, Department of Gynaecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu 222006, P.R. China
    Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 426
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    Published online on: July 28, 2026
       https://doi.org/10.3892/ol.2026.15781
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Abstract

Currently, the determination of the risk level for endometrial cancer (EC) needs to be made after radical surgery, based on factors such as tumour type and differentiation, extent of invasion and clinical stage. If the early diagnosis of high‑risk EC can be improved, it will greatly contribute to enhancing patient survival rates. The present study aimed to construct a nomogram to predict high‑risk EC by combining immunohistochemical (IHC) and serological indicators, and then evaluating and verifying the value of it. A total of 130 patients with EC admitted to Lianyungang Maternal and Child Health Hospital from December 2018 to May 2026 were included. The training set consisted of 107 cases, while the validation set contained 23 cases. All cases were divided into a high‑risk group and a low‑risk group on the basis of the postoperative pathological results. The clinical data, IHC staining results and preoperative serological indicators of the two groups were compared. Logistic regression analysis was used to screen the risk factors for high‑risk EC. A nomogram model was created using R software and then evaluated through receiver operating characteristic (ROC) curves, calibration curves and external validation. In the training set, univariate analysis revealed that the indicators with statistically significant differences between the two groups were age, nuclear‑associated antigen (Ki‑67) expression, oestrogen receptor (ER) expression and the lymphocyte‑to‑monocyte ratio (LMR). Multivariate regression analysis revealed that age, the Ki‑67 index and the LMR were independent risk factors for high‑risk EC (all P<0.05). The results of the nomogram model and ROC curve analysis indicated that, compared with age, the Ki‑67 index and the LMR individually, the combined prediction model constructed from these three factors demonstrated greater diagnostic performance [area under the curve (AUC)=0.904; 95% CI=0.840‑0.968; sensitivity: 75.6%; specificity: 93.9%; P<0.05]. The goodness‑of‑fit test results suggested that the predictive model had a good fit (X2=9.185; P>0.05). Finally, external validation was performed using the validation set, and the results revealed that the model had good predictive performance (AUC=0.846), with a prediction accuracy of 73.9%. Therefore, this study designed and validated a nomogram based on age, Ki‑67 index and LMR, which has good diagnostic value for screening high‑risk patients with EC.
View Figures

Figure 1

Receiver operating characteristic
curve of Age, Ki-67, LMR and the prediction model for high-risk EC
from the training set.

Figure 2

Calibration curve of the nomogram
prediction model for high-risk EC.

Figure 3

Receiver operating characteristic
curve of the prediction model for high-risk EC from validation set
(area under the curve=0.846 and P<0.05).

Figure 4

Nomogram prediction model for
high-risk EC.
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Copy and paste a formatted citation
Spandidos Publications style
Chen Y, Li J, Yan L, Liu P, Meng F and Zhang Y: A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma. Oncol Lett 32: 426, 2026.
APA
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., & Zhang, Y. (2026). A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma. Oncology Letters, 32, 426. https://doi.org/10.3892/ol.2026.15781
MLA
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., Zhang, Y."A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma". Oncology Letters 32.4 (2026): 426.
Chicago
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., Zhang, Y."A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma". Oncology Letters 32, no. 4 (2026): 426. https://doi.org/10.3892/ol.2026.15781
Copy and paste a formatted citation
x
Spandidos Publications style
Chen Y, Li J, Yan L, Liu P, Meng F and Zhang Y: A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma. Oncol Lett 32: 426, 2026.
APA
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., & Zhang, Y. (2026). A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma. Oncology Letters, 32, 426. https://doi.org/10.3892/ol.2026.15781
MLA
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., Zhang, Y."A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma". Oncology Letters 32.4 (2026): 426.
Chicago
Chen, Y., Li, J., Yan, L., Liu, P., Meng, F., Zhang, Y."A nomogram based on immunohistochemistry and lymphocyte‑to‑monocyte ratio for predicting risk stratification in endometrial carcinoma". Oncology Letters 32, no. 4 (2026): 426. https://doi.org/10.3892/ol.2026.15781
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