Table 5.
Circulating endometrial cancer prognostic biomarkers.
| Category | Biomarker | Prognostic features |
|---|---|---|
| Proteins | Elevated CA125 | Linked to poor survival (96, 97) Higher stage (83, 98) Higher grade (83, 98) Deep myometrial invasion (83, 98) Lymph node metastasis (83, 98) LVSI (98) |
| Elevated HE4 | Poor overall, disease-specific and recurrence free survival (74, 84) Deep myometrial invasion (99, 100) Advanced stage (100–102) Presence of LVSI (66, 103) Tumour size (100) Lymph node metastasis (99, 103) Recurrence (103) |
|
| High Estriol (E3) High Estrone sufate (E1-S) |
Non-myoinvasive tumours, low risk of recurrence and improved overall survival (104) Increased relapse (104) |
|
| Metabolites | Bradykinin, heme, lactic acid, homocysteine, myristic acid, valine, progesterone, threonine, stearic acid, sarcosine, glycine etc | Associated with histological subtype (13, 105, 106) |
| Hydroxysphingomyelins, phospatidylcholines, estrogen metabolites | Associated with deep myometrial invasion (13, 106–108) | |
| Hexadecadienyl carnitine, phosphatidylcholines | Associated with LVSI (13, 107) | |
| Spermine, acylcholines, sphingolipids, linoleic acid, myristic acid, polyamines, ceramides | Associated with recurrence (13, 105) | |
| Methionine sulfoxide | Poor survival (109) | |
| Circulating tumour cells (CTC) |
Detection of CTC | Poor progression-free survival (92) Association with non-endometrioid cancer (92) Large tumour size (>5cm) (92) Lymph node involvement (93) Deep myometrial invasion (93) |
| Circulating tumour DNA (ctDNA) |
Presence of ctDNA | Associated with type II tumours (87). Elevated in grades 2 and 3 endometrial cancer (85, 86) |
| Serum ctDNA integrity | Elevated in LVSI (85) | |
| Plasma p53 antibody | Linked to serous tumours (87) Linked to higher grade in Type I tumours (87) |
|
| Plasma KRAS mutation | Elevated in grade 2 of type I tumours (87) | |
| Presence of plasma mutation (CTNNBI, KRAS, PTEN, or PIK3CA) | Linked to tumour stage (91) Deep myometrial invasion (91) LVSI (91) Large tumour size (91) |
|
| Immune/inflammatory parameters | Elevated CRP | Associated with poor overall and cancer-specific survival(65, 80, 81, 110) Stage (111, 112) Lymph node involvement (112) |
| Glasgow prognostic score | Survival and recurrence (113) | |
| Inflammatory parameters (NLR,MLR,PLR,SII etc) | Adverse clinico-pathological features and outcomes (94, 95, 114–117) |