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Preoperative Leukocytosis Imposes an Increased Risk of Recurrence and Death Among Patients With Nonendometrioid Endometrial Carcinoma

Worley, Michael J. Jr MD*; Nitschmann, Caroline C. MD; Shoni, Melina MD*; Rauh-Hain, Jose Alejandro MD; Williams, Kristina A. BS§; Feltmate, Colleen M. MD*

International Journal of Gynecological Cancer: February 2013 - Volume 23 - Issue 2 - p 312–317
doi: 10.1097/IGC.0b013e31827da21b
Uterine Cancer

Objective: To evaluate the impact of preoperative leukocytosis among patients with nonendometrioid endometrial carcinoma.

Methods: The medical records of all patients with nonendometrioid endometrial carcinoma who underwent surgical treatment between January 2005 and December 2010 were retrospectively reviewed. The patients were separated into 2 groups based on the presence or absence of preoperative leukocytosis (white blood cell count ≥10,000/μL). The groups were then compared with respect to pathologic findings, progression-free survival, and overall survival.

Results: A total of 222 patients were identified, and preoperative leukocytosis was observed in 33 patients (14.9%). The leukocytosis group was associated with a larger mean size of the primary tumor (6.8 vs 4.6 cm, P = 0.016) and a greater percentage of patients with cervical stromal involvement (36.4% vs 20.1%, P = 0.039), adnexal involvement (42.4% vs. 22.8%, P = 0.017), and pelvic/para-aortic lymph node involvement (50% vs 27.4%, P = 0.025). On multivariate analysis, preoperative leukocytosis was independently associated with an increased risk of recurrence (hazard ratio, 2.07; 95% confidence interval, 1.12–3.84) and an increased risk of death (hazard ratio, 3.33; 95% confidence interval, 2.01–5.53).

Conclusions: Among patients with nonendometrioid endometrial carcinoma, preoperative leukocytosis is independently associated with an increased risk of recurrence and death.

*Division of Gynecologic Oncology, and †Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital; ‡Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital; and §Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Colleen Feltmate, MD, Division of Gynecologic Oncology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail:

The authors declare conflicts of interest.

Received Sept 18, 2012

Accepted November 11, 2012

Copyright © 2013 by IGCS and ESGO