Systemic inflammatory indices and CA-125 in Endometriosis: Expression and Clinical Significance

Systemic inflammatory indices and CA-125 in Endometriosis: Expression and Clinical Significance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Systemic inflammatory indices and CA-125 in Endometriosis: Expression and Clinical Significance Ying Jiang, Wenting Jiang, Ruobin Zhong, Jingxian Xie, Liying Zhong, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-10484565/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective To investigate the expression and clinical significance of systemic inflammatory indices and serum CA-125 in endometriosis, and to compare their diagnostic efficacy. Methods Clinical data were collected from 252 patients with endometriosis (endometriosis group), 214 patients with endometriosis combined with adenomyosis (endometriosis + adenomyosis group), and 97 patients with benign ovarian tumors confirmed by postoperative histopathology (control group) treated at Fujian Provincial Maternity and Child Health Hospital from December 2021 to May 2024. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and other systemic inflammatory indices as well as serum CA-125 levels were compared among the three groups. Their expression and diagnostic utility for adenomyosis and endometriosis were evaluated. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of these markers. Results CA-125, PLR, and dNLR were significantly higher in the endometriosis + adenomyosis group than in the control group (P < 0.05). CA-125 and dNLR were significantly higher, while BLR was significantly lower in the endometriosis group compared with the control group (P < 0.05). Serum CA-125 levels were significantly higher in patients with dysmenorrhea than in those without (P < 0.05). The optimal cutoff value of CA-125 for diagnosing endometriosis was 26.85, with a sensitivity of 79.6%, specificity of 82.9%, and Youden index of 0.625. Conclusion Serum CA-125 can serve as a serum biomarker for the auxiliary diagnosis of endometriosis, and its diagnostic efficacy is superior to that of systemic inflammatory indices. Systemic inflammatory indices CA-125 Endometriosis Figures Figure 1 Figure 2 Introduction Currently, the gold standard for diagnosing endometriosis is direct visualization of endometriotic lesions during laparoscopy combined with histopathological examination of surgically obtained tissue samples. There is still no non-invasive test with acceptable specificity and sufficient sensitivity to accurately diagnose endometriosis preoperatively [ 1 , 2 ] . CA-125 is a protein produced in coelomic epithelial cells present in the endometrium, ovaries, fallopian tubes, and peritoneum [ 3 ] and plays an important role in the diagnosis of ovarian cancer. Clinically, CA-125 levels are elevated in patients with endometriosis; however, CA-125 is easily affected by various gynecological diseases and the menstrual cycle, and its detection is not readily available in primary hospitals. Therefore, identifying simple, feasible, and stable markers to complement the limitations of serum CA-125 has important clinical significance. Studies have shown that immune and inflammatory factors are involved in the pathogenesis of endometriosis, and exploring the relationship between systemic inflammatory indices and endometriosis is of clinical value. Materials and Methods 1. Study subjects Clinical data were collected from 252 patients with endometriosis (endometriosis group) and 214 patients with endometriosis combined with adenomyosis (endometriosis + adenomyosis group) treated at the Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital from December 2021 to May 2024. All diagnoses were confirmed by postoperative pathology. Endometrioma staging was performed according to the revised American Fertility Society (r-AFS) classification: 111 cases of stage III endometriosis and 354 cases of stage IV endometriosis. A total of 97 patients with benign ovarian tumors confirmed by postoperative histopathology who underwent surgery during the same period were selected as the control group; none of the control patients had any other gynecological diseases. Inclusion criteria (1) Patients who underwent surgery at Fujian Provincial Maternity and Child Health Hospital with a postoperative pathological diagnosis of endometriosis; (2) Complete clinical and pathological data; (3) Women of reproductive age (25–45 years). Exclusion criteria (1) Pregnancy, lactation, menopause, or luteal phase; (2) History of hypertension, diabetes, severe cardiac, pulmonary, hepatic, or renal dysfunction, or coagulation abnormalities; (3) Use of steroid hormones, anticoagulants, anti-inflammatory drugs, antihypertensives, antidiabetics, or lipid-lowering agents within 6 months before surgery. 2. Methods All patient-related clinical data were retrieved from the hospital medical record system. Preoperative age, endometriosis stage, pathological type, and other data were recorded. Preoperative peripheral blood CA-125 and hematological parameters were collected. Systemic inflammatory indices were calculated as follows: NLR = neutrophil count / lymphocyte count, MLR = monocyte count / lymphocyte count, PLR = platelet count / lymphocyte count, ELR = eosinophil count / lymphocyte count, BLR = basophil count / lymphocyte count, EBR = eosinophil count / basophil count, dNLR = (white blood cell count – neutrophil count) / lymphocyte count, SIRI = neutrophil count × monocyte count / lymphocyte count, SII = platelet count × neutrophil count / lymphocyte count. Uterine volume was measured by ultrasound and calculated using the ellipsoid formula: uterine volume = 0.52 × anteroposterior diameter (cm) × transverse diameter (cm) × longitudinal diameter (cm). A uterine volume of 180 cm³ (approximately the size of a 10-week pregnant uterus) was used as the cutoff [ 4 , 5 ] . 3. Statistical analysis SPSS 26.0 software was used for statistical analysis. For measurement data that were approximately normally distributed with homogeneous variance, results were expressed as mean ± standard deviation; comparisons between two groups were performed using the t-test, and comparisons among multiple groups were performed using ANOVA. For data that did not meet normal distribution or homogeneity of variance, the nonparametric rank-sum test was used. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC) and analyze the diagnostic value of each parameter for endometriosis and adenomyosis. Univariate factors with statistically significant differences were included in multivariate logistic regression analysis. The diagnostic value of different parameters was described and compared using ROC curves and AUC, and the best predictive indicators were analyzed. A P-value < 0.05 was considered statistically significant. Results 1. Comparison of Systemic inflammatory indices and CA-125 among the three groups Comparison of peripheral blood hematological parameters and CA-125 between the experimental groups (endometriosis group, endometriosis + adenomyosis group) and the control group is shown in Table 1 . The results showed: (1) CA-125 and dNLR were significantly higher in the endometriosis group than in the control group (P < 0.05); BLR was significantly lower in the endometriosis group than in the control group (P < 0.05). (2) CA-125, PLR, and dNLR were significantly higher in the endometriosis + adenomyosis group than in the control group (P < 0.05). Table 1 Comparison of peripheral blood Systemic inflammatory indices and CA-125 among the three groups Parameter Endometriosis (n = 252) Endometriosis + Adenomyosis (n = 214) Benign ovarian tumor (n = 97) P1 P2 CA-125 71.37 ± 91.64 90.48 ± 135.79 19.49 ± 10.65 < 0.001★ < 0.001△ NLR 1.99 ± 1.14 2.12 ± 0.82 2.12 ± 1.21 0.300 0.999 MLR 0.186 ± 0.068 0.203 ± 0.074 0.192 ± 0.079 0.468 0.224 PLR 149.36 ± 58.05 159.82 ± 58.69 145.62 ± 52.32 0.586 0.044△ ELR 0.058 ± 0.047 0.061 ± 0.048 0.056 ± 0.042 0.798 0.392 BLR 0.016 ± 0.009 0.019 ± 0.011 0.020 ± 0.011 0.003★ 0.273 EBR 4.97 ± 4.06 3.95 ± 3.70 3.43 ± 2.67 0.157 0.255 dNLR 1.26 ± 0.09 1.28 ± 0.10 1.16 ± 0.92 0.034★ 0.011△ SIRI 0.693 ± 0.449 0.775 ± 0.395 0.757 ± 0.597 0.247 0.752 SII 546.83 ± 339.50 606.94 ± 296.17 554.64 ± 320.19 0.975 0.119 P1: Endometriosis group vs. control group; ★ indicates statistically significant difference (P < 0.05). P2: Endometriosis + adenomyosis group vs. control group; △ indicates statistically significant difference (P < 0.05). 2. ROC curve analysis of CA-125, BLR, and dNLR for diagnosing endometriosis ROC curve analysis was performed for CA-125, BLR, and dNLR, which showed statistically significant differences between the endometriosis group and the control group (Table 5 , Fig. 1 A). CA-125 demonstrated moderate diagnostic accuracy (0.7 < AUC = 0.880 < 0.9). The optimal cutoff value was 26.85, with a sensitivity of 79.6%, specificity of 82.9%, and Youden index of 0.625. The AUC values for BLR and dNLR were 0.585 and 0.522, respectively, indicating low diagnostic value (0.50 ≤ AUC ≤ 0.70). Using logistic regression analysis, the predicted probabilities of CA-125 combined with BLR and CA-125 combined with dNLR were plotted as ROC curves (Fig. 1 B). The AUC values were 0.887 and 0.880, respectively, with no significant difference compared with CA-125 alone (AUC = 0.880), indicating no improvement in diagnostic efficacy. Similarly, the diagnostic value of CA-125, PLR, and dNLR for endometriosis combined with adenomyosis was analyzed (Table 6 , Figs. 2 A, 2 B). The AUC values for PLR and dNLR were 0.567 and 0.544, respectively. The AUC values for CA-125 combined with PLR and CA-125 combined with dNLR were 0.908 and 0.909, respectively, with no significant difference compared with CA-125 alone (AUC = 0.909), indicating no improvement in accuracy. Table 2. ROC curve analysis of CA-125, BLR, and dNLR (endometriosis vs. control) Parameter AUC Std. error P value 95% CI BLR 0.585 0.038 0.025★ 0.341–0.490 dNLR 0.578 0.038 0.565 0.404–0.553 CA-125 0.880 0.020 < 0.001★ 0.841–0.920 ★ P < 0.05 indicates that the model has good predictive ability Table 3. ROC curve analysis of CA-125, PLR, and dNLR (endometriosis + adenomyosis vs. control) Parameter AUC Std. error P value 95% CI PLR 0.567 0.039 0.084 0.490–0.644 dNLR 0.544 0.039 0.253 0.467–0.621 CA-125 0.909 0.018 < 0.001★ 0.874–0.943 ★ P < 0.05 indicates that the model has good predictive ability Figure 1 A: ROC curve for individual parameter diagnosis of uterine adenomyosis; B: ROC curve for combined diagnosis of uterine adenomyosis using various parameters and CA125 We further investigated the correlations between endometriosis stage, dysmenorrhea, uterine size in adenomyosis, and peripheral blood cell-derived inflammatory markers as well as CA125. Our findings revealed that endometriosis patients with dysmenorrhea had significantly higher CA125 levels, with a statistically significant difference (P < 0.05). CA125 may serve as a useful indicator for assessing symptom improvement following pharmacological or surgical treatment. No significant differences were observed in blood cell-derived inflammatory markers between patients with and without dysmenorrhea. 3. Correlation analysis of peripheral blood markers with disease stage Comparison of hematological parameters and CA-125 between different endometriosis stages (stage III, n = 111; stage IV, n = 354) is shown in Table 2. There were no statistically significant differences in CA-125 or any systemic inflammatory indices between stage III and stage IV. Table 4 Correlation of peripheral blood markers with disease stage Parameter Stage III Stage IV F P CA-125 63.04 ± 89.14 85.64 ± 120.88 3.312 0.069 NLR 2.01 ± 0.95 2.07 ± 1.03 0.239 0.625 MLR 0.193 ± 0.071 0.194 ± 0.071 0.005 0.944 PLR 149.90 ± 56.23 155.59 ± 59.28 0.797 0.372 ELR 0.060 ± 0.050 0.059 ± 0.047 0.131 0.718 BLR 0.018 ± 0.012 0.017 ± 0.010 0.134 0.715 EBR 4.22 ± 4.43 3.95 ± 3.72 0.403 0.526 dNLR 1.271 ± 0.101 1.270 ± 0.097 0.026 0.871 SIRI 0.718 ± 0.429 0.736 ± 0.427 0.148 0.700 SII 542.27 ± 275.97 584.95 ± 334.41 1.489 0.223 ★ Statistically significant difference (P < 0.05). Table 5 Correlation of peripheral blood markers with dysmenorrhea Parameter No dysmenorrhea Dysmenorrhea F P CA-125 61.97 ± 77.79 93.11 ± 131.09 8.538 0.004★ NLR 2.026 ± 0.854 2.072 ± 1.104 0.237 0.627 MLR 0.199 ± 0.071 0.190 ± 0.071 2.107 0.147 PLR 151.97 ± 59.67 155.73 ± 57.74 0.469 0.494 ELR 0.0589 ± 0.0480 0.0593 ± 0.0476 0.008 0.930 BLR 0.018 ± 0.011 0.017 ± 0.010 1.276 0.259 EBR 3.61 ± 3.01 4.29 ± 4.39 3.302 0.070 dNLR 1.276 ± 0.099 1.266 ± 0.097 1.262 0.262 SIRI 0.734 ± 0.370 0.728 ± 0.464 0.021 0.885 SII 558.47 ± 289.39 585.82 ± 342.47 0.820 0.366 ★ Statistically significant difference (P < 0.05). 5. Correlation analysis of peripheral blood markers with uterine volume Uterine volume was analyzed in the endometriosis + adenomyosis group (Table 4 ). Neither CA-125 nor systemic inflammatory indices showed a significant association with uterine volume in patients with adenomyosis (all P 0.05). Table 6 Correlation of peripheral blood markers with uterine volume Parameter Uterine volume ≤ 180 cm³ Uterine volume 180 cm³ F P CA-125 78.23 ± 116.84 102.62 ± 80.61 1.587 0.208 NLR 2.05 ± 1.03 2.11 ± 0.77 0.114 0.736 MLR 0.192 ± 0.071 0.209 ± 0.066 1.929 0.165 PLR 153.27 ± 57.57 165.48 ± 68.35 1.520 0.218 ELR 0.058 ± 0.048 0.066 ± 0.048 0.980 0.323 BLR 0.173 ± 0.010 0.0183 ± 0.013 0.321 0.571 EBR 3.93 ± 3.74 4.89 ± 5.32 1.990 0.159 dNLR 1.27 ± 0.10 1.29 ± 0.10 2.394 0.122 SIRI 0.722 ± 0.430 0.828 ± 0.389 2.146 0.144 SII 569.48 ± 324.81 634.61 ± 280.48 1.432 0.232 ★ Statistically significant difference (P < 0.05). Discussion Peripheral blood systemic inflammatory indices, such as NLR and dNLR, are simple and economical peripheral blood markers that are considered surrogate markers of systemic inflammatory response [ 6 ] . They reflect a relative increase in circulating neutrophils and a decrease in lymphocytes, which play a central role in anti-tumor immune surveillance. Thus, elevated NLR, dNLR, and SII may indicate a pro-tumor immune environment, potentially leading to worse clinical outcomes, and have important clinical significance for the diagnosis and treatment of related diseases [ 7 , 8 ] . In recent years, systemic inflammatory indices such as NLR, PLR, and SII have been found to be elevated in the serum of many tumor patients, including those with endometrial cancer, ovarian cancer, gastric cancer, colorectal cancer, and lung cancer, and can serve as predictive indicators of disease and reflect systemic inflammatory status [ 7 – 14 ] . The results of this study showed that compared with the control group, the mean values of CA-125 and dNLR were significantly higher in the endometriosis group, while the mean value of BLR was significantly lower. In the endometriosis + adenomyosis group, CA-125, PLR, and dNLR were significantly higher than in the control group. dNLR was significantly higher in both the endometriosis group and the endometriosis + adenomyosis group compared with the control group. Many other studies have similarly shown that dNLR can serve as a biomarker reflecting systemic inflammatory status, with potential value in the diagnosis and prognosis of diseases such as non-small cell lung cancer and ankylosing spondylitis [ 6 , 10 ] . The finding that PLR was higher in the adenomyosis group than in the control group is consistent with the study by Li Juan et al. [ 11 ] . Tabatabaei et al. [ 12 ] found in a meta-analysis that a high NLR may serve as a potential predictor for the diagnosis of endometriosis. Another study incorporated PLT and MLR into a predictive model as a risk prediction tool for endometriosis [ 15 ] . However, in the present study, NLR and SII showed no statistically significant differences between the endometriosis group or the endometriosis + adenomyosis group and the control group. Furthermore, although our data suggested a trend toward a higher likelihood of dysmenorrhea in patients with elevated NLR [ 12 ] , no statistically significant correlation was found between NLR and dysmenorrhea in endometriosis. CA-125 is a protein produced in coelomic epithelial cells present in the endometrium, ovaries, fallopian tubes, and peritoneum. It is elevated in the serum of many tumor patients, including those with endometrial cancer, fallopian tube cancer, and gastrointestinal malignancies [ 16 ] . In patients with endometriosis, ectopic endometrial tissue in the peritoneal cavity stimulates coelomic mesothelial cells, leading to elevated CA-125 levels [ 17 ] . Notably, CA-125 is currently the best single serum marker for ovarian cancer, and the clinical threshold of 35 U/mL is widely accepted for the detection of ovarian cancer [ 14 ] . As a non-invasive serum marker, CA-125 has been extensively studied for the diagnosis of endometriosis [ 18 ] . A study by Nouri et al. calculated an AUC of 0.896 for CA-125 with an optimal cutoff value of 12.7 (specificity = 60.9%, sensitivity = 93.9%) [ 1 ] . In our data, the optimal cutoff value was 26.85, with a sensitivity of 79.6% and specificity of 82.9%. Generally, the predetermined criteria for a blood test that could replace surgical diagnosis of endometriosis are sensitivity ≥ 0.94 and specificity ≥ 0.79 (replacement test) [ 19 ] . Nisenblat et al. proposed that markers with sensitivity ≥ 0.95 and specificity ≥ 0.50 could be used to accurately rule out negative results (SnOUT test), while markers with specificity ≥ 0.95 and sensitivity ≥ 0.50 could be used for accurate diagnosis of positive results (SpIN test) [ 19 , 20 ] . The present study indicates that CA-125 is a more effective diagnostic marker than peripheral blood systemic inflammatory indices, effectively distinguishing patients with endometriosis from controls; however, its sensitivity and specificity do not support its use as a standalone diagnostic marker. At present, there is no simple non-invasive method to definitively diagnose endometriosis. Many different studies have measured various biomarkers in the hope of replacing laparoscopy for the diagnosis of endometriosis [ 1 , 21 ] . Our results suggest that endometriosis is associated with elevated serum CA-125 and dNLR levels and decreased BLR levels, while endometriosis combined with adenomyosis is associated with elevated serum CA-125, dNLR, and PLR. ROC curve analysis indicated that BLR and PLR have predictive and diagnostic value, but not as significant as CA-125. Therefore, CA-125 is the best single marker for distinguishing endometriosis from controls compared with systemic inflammatory indices such as PLR and dNLR. However, its sensitivity and specificity do not meet the clinically recognized standards for replacement tests, SnOUT tests, or SpIN tests, and are insufficient to definitively diagnose endometriosis. Furthermore, the combined diagnostic models of CA-125 with BLR, PLR, or dNLR showed no significant improvement in AUC compared with CA-125 alone, indicating no enhanced diagnostic efficacy. In summary, despite decades of research, the non-invasive diagnosis of endometriosis remains a major challenge. Numerous clinical studies have investigated various factors, including cytokines, glycoproteins, angiogenic factors, and tumor markers, but no single marker can accurately identify the disease [ 22 , 23 ] . Our study found that PLR and dNLR tend to be elevated in patients with endometriosis. Nevertheless, serum CA-125 remains the single most effective serum marker for the diagnosis of endometriosis, although its sensitivity and specificity still need to be improved through the identification of effective serum markers. Declarations Consent for publication: Not Applicable. Conflicts of interest All authors declare no conflicts of interest. Funding This work was supported by funds from the Natural Science Foundation of Fujian Province(2023J011230) Author Contribution Y. J. was responsible for data analysis and manuscript writing; W. J., R. Z., and J. X.were responsible for data collection and manuscript revision; L. Z., L. W., and O. C. contributed to data analysis and manuscript correction; C. L. was responsible for manuscript guidance and critical review. Data Availability The data that support the findings of this study are derived from Fujian Provincial Maternity and Child Health Hospital. Due to privacy and ethical restrictions, these data are not publicly available. Anonymized data may be available from the corresponding author upon reasonable request, subject to institutional review board approval. Ethics approval This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Ethics Committee of Fujian Provincial Maternity and Child Health Hospital (Approval No.2024KY043). Due to the retrospective nature of the study and the use of anonymized clinical data from routine medical records, the requirement for informed consent was waived by the Ethics Committee. References Nouri B, Talebian N, Kharaz L, et al. Diagnostic value of serum cancer antigen 125, carcinoembryonic antigen, cancer antigen 19 – 9, anti müllerian hormone, white blood cell count, platelet count, and neutrophil to lymphocyte ratio in endometriosis: a retrospective study. Int J Fertil Steril. 2025;19(3):259–63. Saunders PTK, Horne AW, Endometriosis. Improvements and challenges in diagnosis and symptom management. Cell Rep Med. 2024;5(6):101496. Han YH, Zhou YF, Li H et al. Diagnostic value of serum and peritoneal fluid CA-125 measurement for adenomyosis. Chin J Clin Obstet Gynecol, 2001(2): 82–4, 87. Sheth SS, Hajari AR, Lulla CP, et al. Sonographic evaluation of uterine volume and its clinical importance. J Obstet Gynaecol Res. 2017;43(1):185–9. Li T, Xu XX, Dai Y, et al. Menorrhagia and uterine volume associated with lower urinary tract symptoms in patients with adenomyosis. Chin Med J. 2017;130(13):1552–6. Longueville E, Dewolf M, Dalstein V, et al. Comparing neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil count (ANC) and derived NLR as predictive biomarkers in first-line immunotherapy for non-small cell lung cancer: a retrospective study. Transl Lung Cancer Res. 2025;14(4):1212–30. Matsubara S, Mabuchi S, Takeda Y, et al. Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer. PLoS ONE. 2021;16(5):e0248871. Qiu Y, Zhang Z, Chen Y. Prognostic value of pretreatment systemic immune-inflammation index in gastric cancer: a meta-analysis. Front Oncol. 2021;11:537140. Fang J, Li Q, Xu N, et al. Systemic inflammation biomarkers can identify high tumor mutation burden in lung adenocarcinoma. BMC Cancer. 2025;25:1543. Rapapa KA, Deng Y, Peng Y, et al. The association and clinical significance of hematological biomarkers in ankylosing spondylitis. Sci Rep. 2025;15(1):15755. Li J, Shen Y, Dai SY. Research on the significance of blood cells and their derived parameters in endometriosis[J]. Int J Lab Med. 2021;42(5):598–603. Tabatabaei F, Tahernia H, Ghaedi A, et al. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health. 2023;23:576. Chen G, Bao B, Ye Y, et al. Prognostic value of the systemic immune-inflammation index in non-small cell lung cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Front Oncol. 2025;15:1532343. Refaat L, EissaM S, Elnaggar GN, et al. Systemic inflammatory indices comprising monocytes provide a clinical significance for thyroid cancer identification[J/OL]. Sci Rep. 2025;15(1):39967. Liu X, An R, Wang G. Integrating inflammatory biomarkers and demographic variables with machine learning to predict endometriosis risk[J]. Sci Rep. 2025;15(1):42415. Han Q, Shi G, Zhao RH. Clinical application value of serum CA-125 in endometriosis. Chin J Clin Obstet Gynecol. 2019;20(1):94–6. Yu Y, Liu LL. Value of combined detection of serum carbohydrate antigen 125, human epididymis protein 4 and neutrophil-to-lymphocyte ratio in the clinical diagnosis of endometriosis. Matern Child Health Care China. 2024;39(17):3296–9. The predictive diagnostic. value of combined serum detection of CXCL12, VEGF, and CA125 for endometriosis. Med (Baltim). 2025;104(12):e41436. Tian Z, Chang XH, Zhao Y, et al. Current biomarkers for the detection of endometriosis. Chin Med J. 2020;133(19):2346–52. Nisenblat V, Bossuyt PM, Shaikh R, et al. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2016(5):CD012179. Irungu S, Mavrelos D, Worthington J, et al. Discovery of non-invasive biomarkers for the diagnosis of endometriosis. Clin Proteomics. 2019;16:14. Brulport A, Bourdon M, Vaiman D, et al. An integrated multi-tissue approach for endometriosis candidate biomarkers: a systematic review. Reprod Biol Endocrinol. 2024;22:21. Gibbons T, Rahmioglu N, Zondervan KT, et al. Crimson clues: advancing endometriosis detection and management with novel blood biomarkers. Fertil Steril. 2024;121(1):145–63. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 04 Aug, 2026 Editor assigned by journal 04 Aug, 2026 Editor invited by journal 04 Aug, 2026 Submission checks completed at journal 04 Aug, 2026 First submitted to journal 03 Aug, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-10484565","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":693068825,"identity":"29ebfa55-02b3-4f85-bbfe-bae2277d6e5a","order_by":0,"name":"Ying Jiang","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Jiang","suffix":""},{"id":693068827,"identity":"9f84b553-9556-475c-bfd6-cd0af568dbc5","order_by":1,"name":"Wenting Jiang","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenting","middleName":"","lastName":"Jiang","suffix":""},{"id":693068828,"identity":"b0e7a549-278a-419b-b07e-9d36de61455e","order_by":2,"name":"Ruobin Zhong","email":"","orcid":"","institution":"Guangze County Maternal and Child Health Care Hospital, Nanping City, Fujian Province","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ruobin","middleName":"","lastName":"Zhong","suffix":""},{"id":693068829,"identity":"3a510535-83ba-4599-9638-619e3ee3dc52","order_by":3,"name":"Jingxian Xie","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingxian","middleName":"","lastName":"Xie","suffix":""},{"id":693068830,"identity":"c5a9bd7a-b3b9-41ae-8ba6-37d6973114e6","order_by":4,"name":"Liying Zhong","email":"","orcid":"","institution":"Fujian Provincial Maternity and Child Health Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liying","middleName":"","lastName":"Zhong","suffix":""},{"id":693068831,"identity":"6a4a5bb7-5bcb-41d1-bd75-641f19aa9d8d","order_by":5,"name":"Lijing Wu","email":"","orcid":"","institution":"Fujian Provincial Maternity and Child Health Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lijing","middleName":"","lastName":"Wu","suffix":""},{"id":693068832,"identity":"729cde44-d7d0-4a5c-b003-16a7e9c576e4","order_by":6,"name":"Ou Chen","email":"","orcid":"","institution":"Fujian Provincial Maternity and Child Health Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ou","middleName":"","lastName":"Chen","suffix":""},{"id":693068833,"identity":"38182ace-17ce-486d-bd52-00e7af5d194d","order_by":7,"name":"Chengying Lian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACCTjJ3HCAgcGGh5+/gWgtjCAtaTKSMw4QpYUBrAVIHLYxaEjAr4N/dvOxh1/bLPLkHRgbD/zccZ7HgOEA44ePOXgsuXMs3Vi2TaLY8ABjw8HeM7d5zJkbmCVnbsOtxUAix0xask0icWMD0C+8bbd5LBsOsDHz4tWS/w2u5eDftnM8BgcSCGnJYZP8CNQyH+j9w7xtBwhrkbiRZibNcE4icQNIi2xbMo/kjIPNeP3CPyP5meSPsrrE+Q3Mhz++bbOz5+dvPvjhIx4tIMDMywZ04f0HMD44gvADxh9/GBjkCasbBaNgFIyCkQoAfexUm4AV0qAAAAAASUVORK5CYII=","orcid":"","institution":"Fujian Provincial Maternity and Child Health Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chengying","middleName":"","lastName":"Lian","suffix":""}],"badges":[],"createdAt":"2026-07-26 03:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-10484565/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-10484565/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":116922199,"identity":"482b76f4-d157-4163-b338-9e7dfabbfcec","added_by":"auto","created_at":"2026-08-10 05:40:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":166256,"visible":true,"origin":"","legend":"\u003cp\u003eA: ROC curve for individual parameter diagnosis of uterine adenomyosis;1 B: ROC curve for combined diagnosis of uterine adenomyosis using various parameters and CA125\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-10484565/v1/69bb2c7ab0b05e2869a77af7.png"},{"id":116922277,"identity":"98946262-985b-480b-9573-763c30843aa1","added_by":"auto","created_at":"2026-08-10 05:41:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":189545,"visible":true,"origin":"","legend":"\u003cp\u003eA: ROC curve for individual parameter diagnosis of uterine adenomyosis; B: ROC curve for combined diagnosis of uterine adenomyosis using various parameters and CA125\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-10484565/v1/1ab4145ecd1b3223949b64ce.png"},{"id":116922402,"identity":"46c6a492-b3e6-41ad-9cbf-090df15e0d25","added_by":"auto","created_at":"2026-08-10 05:41:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":609071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-10484565/v1/26617239-c7da-4053-a083-87cc2cb9d082.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Systemic inflammatory indices and CA-125 in Endometriosis: Expression and Clinical Significance","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCurrently, the gold standard for diagnosing endometriosis is direct visualization of endometriotic lesions during laparoscopy combined with histopathological examination of surgically obtained tissue samples. There is still no non-invasive test with acceptable specificity and sufficient sensitivity to accurately diagnose endometriosis preoperatively \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. CA-125 is a protein produced in coelomic epithelial cells present in the endometrium, ovaries, fallopian tubes, and peritoneum \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e and plays an important role in the diagnosis of ovarian cancer. Clinically, CA-125 levels are elevated in patients with endometriosis; however, CA-125 is easily affected by various gynecological diseases and the menstrual cycle, and its detection is not readily available in primary hospitals. Therefore, identifying simple, feasible, and stable markers to complement the limitations of serum CA-125 has important clinical significance. Studies have shown that immune and inflammatory factors are involved in the pathogenesis of endometriosis, and exploring the relationship between systemic inflammatory indices and endometriosis is of clinical value.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\n\u003ch3\u003e1. Study subjects\u003c/h3\u003e\n\u003cp\u003eClinical data were collected from 252 patients with endometriosis (endometriosis group) and 214 patients with endometriosis combined with adenomyosis (endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group) treated at the Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital from December 2021 to May 2024. All diagnoses were confirmed by postoperative pathology. Endometrioma staging was performed according to the revised American Fertility Society (r-AFS) classification: 111 cases of stage III endometriosis and 354 cases of stage IV endometriosis. A total of 97 patients with benign ovarian tumors confirmed by postoperative histopathology who underwent surgery during the same period were selected as the control group; none of the control patients had any other gynecological diseases.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003e(1) Patients who underwent surgery at Fujian Provincial Maternity and Child Health Hospital with a postoperative pathological diagnosis of endometriosis; (2) Complete clinical and pathological data; (3) Women of reproductive age (25\u0026ndash;45 years).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003e(1) Pregnancy, lactation, menopause, or luteal phase; (2) History of hypertension, diabetes, severe cardiac, pulmonary, hepatic, or renal dysfunction, or coagulation abnormalities; (3) Use of steroid hormones, anticoagulants, anti-inflammatory drugs, antihypertensives, antidiabetics, or lipid-lowering agents within 6 months before surgery.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003e2. Methods\u003c/h3\u003e\n\u003cp\u003eAll patient-related clinical data were retrieved from the hospital medical record system. Preoperative age, endometriosis stage, pathological type, and other data were recorded. Preoperative peripheral blood CA-125 and hematological parameters were collected. Systemic inflammatory indices were calculated as follows:\u003c/p\u003e \u003cp\u003eNLR\u0026thinsp;=\u0026thinsp;neutrophil count / lymphocyte count,\u003c/p\u003e \u003cp\u003eMLR\u0026thinsp;=\u0026thinsp;monocyte count / lymphocyte count,\u003c/p\u003e \u003cp\u003ePLR\u0026thinsp;=\u0026thinsp;platelet count / lymphocyte count,\u003c/p\u003e \u003cp\u003eELR\u0026thinsp;=\u0026thinsp;eosinophil count / lymphocyte count,\u003c/p\u003e \u003cp\u003eBLR\u0026thinsp;=\u0026thinsp;basophil count / lymphocyte count,\u003c/p\u003e \u003cp\u003eEBR\u0026thinsp;=\u0026thinsp;eosinophil count / basophil count,\u003c/p\u003e \u003cp\u003edNLR = (white blood cell count \u0026ndash; neutrophil count) / lymphocyte count,\u003c/p\u003e \u003cp\u003eSIRI\u0026thinsp;=\u0026thinsp;neutrophil count \u0026times; monocyte count / lymphocyte count,\u003c/p\u003e \u003cp\u003eSII\u0026thinsp;=\u0026thinsp;platelet count \u0026times; neutrophil count / lymphocyte count.\u003c/p\u003e \u003cp\u003eUterine volume was measured by ultrasound and calculated using the ellipsoid formula: uterine volume\u0026thinsp;=\u0026thinsp;0.52 \u0026times; anteroposterior diameter (cm) \u0026times; transverse diameter (cm) \u0026times; longitudinal diameter (cm). A uterine volume of 180 cm\u0026sup3; (approximately the size of a 10-week pregnant uterus) was used as the cutoff \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e3. Statistical analysis\u003c/h3\u003e\n\u003cp\u003eSPSS 26.0 software was used for statistical analysis. For measurement data that were approximately normally distributed with homogeneous variance, results were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; comparisons between two groups were performed using the t-test, and comparisons among multiple groups were performed using ANOVA. For data that did not meet normal distribution or homogeneity of variance, the nonparametric rank-sum test was used. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC) and analyze the diagnostic value of each parameter for endometriosis and adenomyosis. Univariate factors with statistically significant differences were included in multivariate logistic regression analysis. The diagnostic value of different parameters was described and compared using ROC curves and AUC, and the best predictive indicators were analyzed. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Comparison of Systemic inflammatory indices and CA-125 among the three groups\u003c/h3\u003e\n\u003cp\u003eComparison of peripheral blood hematological parameters and CA-125 between the experimental groups (endometriosis group, endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group) and the control group is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The results showed: (1) CA-125 and dNLR were significantly higher in the endometriosis group than in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); BLR was significantly lower in the endometriosis group than in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (2) CA-125, PLR, and dNLR were significantly higher in the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group than in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of peripheral blood Systemic inflammatory indices and CA-125 among the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometriosis (n\u0026thinsp;=\u0026thinsp;252)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndometriosis\u0026thinsp;+\u0026thinsp;Adenomyosis (n\u0026thinsp;=\u0026thinsp;214)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBenign ovarian tumor (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e71.37\u0026thinsp;\u0026plusmn;\u0026thinsp;91.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e90.48\u0026thinsp;\u0026plusmn;\u0026thinsp;135.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.49\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001△\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.186\u0026thinsp;\u0026plusmn;\u0026thinsp;0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.203\u0026thinsp;\u0026plusmn;\u0026thinsp;0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.192\u0026thinsp;\u0026plusmn;\u0026thinsp;0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e149.36\u0026thinsp;\u0026plusmn;\u0026thinsp;58.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e159.82\u0026thinsp;\u0026plusmn;\u0026thinsp;58.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e145.62\u0026thinsp;\u0026plusmn;\u0026thinsp;52.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.044△\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eELR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.061\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.056\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.016\u0026thinsp;\u0026plusmn;\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.019\u0026thinsp;\u0026plusmn;\u0026thinsp;0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.020\u0026thinsp;\u0026plusmn;\u0026thinsp;0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011△\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.693\u0026thinsp;\u0026plusmn;\u0026thinsp;0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.775\u0026thinsp;\u0026plusmn;\u0026thinsp;0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.757\u0026thinsp;\u0026plusmn;\u0026thinsp;0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e546.83\u0026thinsp;\u0026plusmn;\u0026thinsp;339.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e606.94\u0026thinsp;\u0026plusmn;\u0026thinsp;296.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e554.64\u0026thinsp;\u0026plusmn;\u0026thinsp;320.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e P1: Endometriosis group vs. control group; ★ indicates statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eP2: Endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group vs. control group; △ indicates statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003e2. ROC curve analysis of CA-125, BLR, and dNLR for diagnosing endometriosis\u003c/h3\u003e\n\u003cp\u003eROC curve analysis was performed for CA-125, BLR, and dNLR, which showed statistically significant differences between the endometriosis group and the control group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). CA-125 demonstrated moderate diagnostic accuracy (0.7\u0026thinsp;\u0026lt;\u0026thinsp;AUC\u0026thinsp;=\u0026thinsp;0.880\u0026thinsp;\u0026lt;\u0026thinsp;0.9). The optimal cutoff value was 26.85, with a sensitivity of 79.6%, specificity of 82.9%, and Youden index of 0.625. The AUC values for BLR and dNLR were 0.585 and 0.522, respectively, indicating low diagnostic value (0.50\u0026thinsp;\u0026le;\u0026thinsp;AUC\u0026thinsp;\u0026le;\u0026thinsp;0.70). Using logistic regression analysis, the predicted probabilities of CA-125 combined with BLR and CA-125 combined with dNLR were plotted as ROC curves (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The AUC values were 0.887 and 0.880, respectively, with no significant difference compared with CA-125 alone (AUC\u0026thinsp;=\u0026thinsp;0.880), indicating no improvement in diagnostic efficacy.\u003c/p\u003e \u003cp\u003eSimilarly, the diagnostic value of CA-125, PLR, and dNLR for endometriosis combined with adenomyosis was analyzed (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The AUC values for PLR and dNLR were 0.567 and 0.544, respectively. The AUC values for CA-125 combined with PLR and CA-125 combined with dNLR were 0.908 and 0.909, respectively, with no significant difference compared with CA-125 alone (AUC\u0026thinsp;=\u0026thinsp;0.909), indicating no improvement in accuracy.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 2. ROC curve analysis of CA-125, BLR, and dNLR (endometriosis vs. control)\u003c/strong\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.341\u0026ndash;0.490\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.404\u0026ndash;0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.841\u0026ndash;0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e★ P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates that the model has good predictive ability\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 3. ROC curve analysis of CA-125, PLR, and dNLR (endometriosis + adenomyosis vs. control)\u003c/strong\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.490\u0026ndash;0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.467\u0026ndash;0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001★\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.874\u0026ndash;0.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e★ P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates that the model has good predictive ability\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eA: ROC curve for individual parameter diagnosis of uterine adenomyosis; B: ROC curve for combined diagnosis of uterine adenomyosis using various parameters and CA125\u003c/p\u003e \u003cp\u003eWe further investigated the correlations between endometriosis stage, dysmenorrhea, uterine size in adenomyosis, and peripheral blood cell-derived inflammatory markers as well as CA125. Our findings revealed that endometriosis patients with dysmenorrhea had significantly higher CA125 levels, with a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CA125 may serve as a useful indicator for assessing symptom improvement following pharmacological or surgical treatment. No significant differences were observed in blood cell-derived inflammatory markers between patients with and without dysmenorrhea.\u003c/p\u003e\n\u003ch3\u003e3. Correlation analysis of peripheral blood markers with disease stage\u003c/h3\u003e\n\u003cp\u003eComparison of hematological parameters and CA-125 between different endometriosis stages (stage III, n\u0026thinsp;=\u0026thinsp;111; stage IV, n\u0026thinsp;=\u0026thinsp;354) is shown in Table\u0026nbsp;2. There were no statistically significant differences in CA-125 or any systemic inflammatory indices between stage III and stage IV.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of peripheral blood markers with disease stage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e63.04\u0026thinsp;\u0026plusmn;\u0026thinsp;89.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e85.64\u0026thinsp;\u0026plusmn;\u0026thinsp;120.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.194\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e149.90\u0026thinsp;\u0026plusmn;\u0026thinsp;56.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e155.59\u0026thinsp;\u0026plusmn;\u0026thinsp;59.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eELR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.060\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.059\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.018\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.017\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.271\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.270\u0026thinsp;\u0026plusmn;\u0026thinsp;0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.718\u0026thinsp;\u0026plusmn;\u0026thinsp;0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.736\u0026thinsp;\u0026plusmn;\u0026thinsp;0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e542.27\u0026thinsp;\u0026plusmn;\u0026thinsp;275.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e584.95\u0026thinsp;\u0026plusmn;\u0026thinsp;334.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e★ Statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of peripheral blood markers with dysmenorrhea\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo dysmenorrhea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDysmenorrhea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e61.97\u0026thinsp;\u0026plusmn;\u0026thinsp;77.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e93.11\u0026thinsp;\u0026plusmn;\u0026thinsp;131.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004★\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.026\u0026thinsp;\u0026plusmn;\u0026thinsp;0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.072\u0026thinsp;\u0026plusmn;\u0026thinsp;1.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.199\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.190\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e151.97\u0026thinsp;\u0026plusmn;\u0026thinsp;59.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e155.73\u0026thinsp;\u0026plusmn;\u0026thinsp;57.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eELR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.0589\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.0593\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.018\u0026thinsp;\u0026plusmn;\u0026thinsp;0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.017\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.276\u0026thinsp;\u0026plusmn;\u0026thinsp;0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.266\u0026thinsp;\u0026plusmn;\u0026thinsp;0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.734\u0026thinsp;\u0026plusmn;\u0026thinsp;0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.728\u0026thinsp;\u0026plusmn;\u0026thinsp;0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e558.47\u0026thinsp;\u0026plusmn;\u0026thinsp;289.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e585.82\u0026thinsp;\u0026plusmn;\u0026thinsp;342.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e★ Statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003e5. Correlation analysis of peripheral blood markers with uterine volume\u003c/h3\u003e\n\u003cp\u003eUterine volume was analyzed in the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Neither CA-125 nor systemic inflammatory indices showed a significant association with uterine volume in patients with adenomyosis (all P 0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of peripheral blood markers with uterine volume\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUterine volume\u0026thinsp;\u0026le;\u0026thinsp;180 cm\u0026sup3;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUterine volume 180 cm\u0026sup3;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA-125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e78.23\u0026thinsp;\u0026plusmn;\u0026thinsp;116.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e102.62\u0026thinsp;\u0026plusmn;\u0026thinsp;80.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.192\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.209\u0026thinsp;\u0026plusmn;\u0026thinsp;0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e153.27\u0026thinsp;\u0026plusmn;\u0026thinsp;57.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e165.48\u0026thinsp;\u0026plusmn;\u0026thinsp;68.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eELR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.066\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.173\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.0183\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.722\u0026thinsp;\u0026plusmn;\u0026thinsp;0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.828\u0026thinsp;\u0026plusmn;\u0026thinsp;0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e569.48\u0026thinsp;\u0026plusmn;\u0026thinsp;324.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e634.61\u0026thinsp;\u0026plusmn;\u0026thinsp;280.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e★ Statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePeripheral blood systemic inflammatory indices, such as NLR and dNLR, are simple and economical peripheral blood markers that are considered surrogate markers of systemic inflammatory response \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. They reflect a relative increase in circulating neutrophils and a decrease in lymphocytes, which play a central role in anti-tumor immune surveillance. Thus, elevated NLR, dNLR, and SII may indicate a pro-tumor immune environment, potentially leading to worse clinical outcomes, and have important clinical significance for the diagnosis and treatment of related diseases \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. In recent years, systemic inflammatory indices such as NLR, PLR, and SII have been found to be elevated in the serum of many tumor patients, including those with endometrial cancer, ovarian cancer, gastric cancer, colorectal cancer, and lung cancer, and can serve as predictive indicators of disease and reflect systemic inflammatory status \u003csup\u003e[\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of this study showed that compared with the control group, the mean values of CA-125 and dNLR were significantly higher in the endometriosis group, while the mean value of BLR was significantly lower. In the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group, CA-125, PLR, and dNLR were significantly higher than in the control group. dNLR was significantly higher in both the endometriosis group and the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group compared with the control group. Many other studies have similarly shown that dNLR can serve as a biomarker reflecting systemic inflammatory status, with potential value in the diagnosis and prognosis of diseases such as non-small cell lung cancer and ankylosing spondylitis \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The finding that PLR was higher in the adenomyosis group than in the control group is consistent with the study by Li Juan et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Tabatabaei et al. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e found in a meta-analysis that a high NLR may serve as a potential predictor for the diagnosis of endometriosis. Another study incorporated PLT and MLR into a predictive model as a risk prediction tool for endometriosis\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. However, in the present study, NLR and SII showed no statistically significant differences between the endometriosis group or the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group and the control group. Furthermore, although our data suggested a trend toward a higher likelihood of dysmenorrhea in patients with elevated NLR \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, no statistically significant correlation was found between NLR and dysmenorrhea in endometriosis.\u003c/p\u003e \u003cp\u003eCA-125 is a protein produced in coelomic epithelial cells present in the endometrium, ovaries, fallopian tubes, and peritoneum. It is elevated in the serum of many tumor patients, including those with endometrial cancer, fallopian tube cancer, and gastrointestinal malignancies \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. In patients with endometriosis, ectopic endometrial tissue in the peritoneal cavity stimulates coelomic mesothelial cells, leading to elevated CA-125 levels \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Notably, CA-125 is currently the best single serum marker for ovarian cancer, and the clinical threshold of 35 U/mL is widely accepted for the detection of ovarian cancer \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. As a non-invasive serum marker, CA-125 has been extensively studied for the diagnosis of endometriosis \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. A study by Nouri et al. calculated an AUC of 0.896 for CA-125 with an optimal cutoff value of 12.7 (specificity\u0026thinsp;=\u0026thinsp;60.9%, sensitivity\u0026thinsp;=\u0026thinsp;93.9%) \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In our data, the optimal cutoff value was 26.85, with a sensitivity of 79.6% and specificity of 82.9%. Generally, the predetermined criteria for a blood test that could replace surgical diagnosis of endometriosis are sensitivity\u0026thinsp;\u0026ge;\u0026thinsp;0.94 and specificity\u0026thinsp;\u0026ge;\u0026thinsp;0.79 (replacement test) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Nisenblat et al. proposed that markers with sensitivity\u0026thinsp;\u0026ge;\u0026thinsp;0.95 and specificity\u0026thinsp;\u0026ge;\u0026thinsp;0.50 could be used to accurately rule out negative results (SnOUT test), while markers with specificity\u0026thinsp;\u0026ge;\u0026thinsp;0.95 and sensitivity\u0026thinsp;\u0026ge;\u0026thinsp;0.50 could be used for accurate diagnosis of positive results (SpIN test) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The present study indicates that CA-125 is a more effective diagnostic marker than peripheral blood systemic inflammatory indices, effectively distinguishing patients with endometriosis from controls; however, its sensitivity and specificity do not support its use as a standalone diagnostic marker.\u003c/p\u003e \u003cp\u003eAt present, there is no simple non-invasive method to definitively diagnose endometriosis. Many different studies have measured various biomarkers in the hope of replacing laparoscopy for the diagnosis of endometriosis \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Our results suggest that endometriosis is associated with elevated serum CA-125 and dNLR levels and decreased BLR levels, while endometriosis combined with adenomyosis is associated with elevated serum CA-125, dNLR, and PLR. ROC curve analysis indicated that BLR and PLR have predictive and diagnostic value, but not as significant as CA-125. Therefore, CA-125 is the best single marker for distinguishing endometriosis from controls compared with systemic inflammatory indices such as PLR and dNLR. However, its sensitivity and specificity do not meet the clinically recognized standards for replacement tests, SnOUT tests, or SpIN tests, and are insufficient to definitively diagnose endometriosis. Furthermore, the combined diagnostic models of CA-125 with BLR, PLR, or dNLR showed no significant improvement in AUC compared with CA-125 alone, indicating no enhanced diagnostic efficacy.\u003c/p\u003e \u003cp\u003eIn summary, despite decades of research, the non-invasive diagnosis of endometriosis remains a major challenge. Numerous clinical studies have investigated various factors, including cytokines, glycoproteins, angiogenic factors, and tumor markers, but no single marker can accurately identify the disease \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Our study found that PLR and dNLR tend to be elevated in patients with endometriosis. Nevertheless, serum CA-125 remains the single most effective serum marker for the diagnosis of endometriosis, although its sensitivity and specificity still need to be improved through the identification of effective serum markers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConsent for publication:\u003c/h2\u003e \u003cp\u003eNot Applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest\u003c/strong\u003e \u003cp\u003eAll authors declare no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by funds from the Natural Science Foundation of Fujian Province(2023J011230)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY. J. was responsible for data analysis and manuscript writing; W. J., R. Z., and J. X.were responsible for data collection and manuscript revision; L. Z., L. W., and O. C. contributed to data analysis and manuscript correction; C. L. was responsible for manuscript guidance and critical review.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are derived from Fujian Provincial Maternity and Child Health Hospital. Due to privacy and ethical restrictions, these data are not publicly available. Anonymized data may be available from the corresponding author upon reasonable request, subject to institutional review board approval.\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Ethics Committee of Fujian Provincial Maternity and Child Health Hospital (Approval No.2024KY043). Due to the retrospective nature of the study and the use of anonymized clinical data from routine medical records, the requirement for informed consent was waived by the Ethics Committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNouri B, Talebian N, Kharaz L, et al. Diagnostic value of serum cancer antigen 125, carcinoembryonic antigen, cancer antigen 19\u0026thinsp;\u0026ndash;\u0026thinsp;9, anti m\u0026uuml;llerian hormone, white blood cell count, platelet count, and neutrophil to lymphocyte ratio in endometriosis: a retrospective study. Int J Fertil Steril. 2025;19(3):259\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaunders PTK, Horne AW, Endometriosis. Improvements and challenges in diagnosis and symptom management. Cell Rep Med. 2024;5(6):101496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan YH, Zhou YF, Li H et al. Diagnostic value of serum and peritoneal fluid CA-125 measurement for adenomyosis. Chin J Clin Obstet Gynecol, 2001(2): 82\u0026ndash;4, 87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheth SS, Hajari AR, Lulla CP, et al. Sonographic evaluation of uterine volume and its clinical importance. J Obstet Gynaecol Res. 2017;43(1):185\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi T, Xu XX, Dai Y, et al. Menorrhagia and uterine volume associated with lower urinary tract symptoms in patients with adenomyosis. Chin Med J. 2017;130(13):1552\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLongueville E, Dewolf M, Dalstein V, et al. Comparing neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil count (ANC) and derived NLR as predictive biomarkers in first-line immunotherapy for non-small cell lung cancer: a retrospective study. Transl Lung Cancer Res. 2025;14(4):1212\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsubara S, Mabuchi S, Takeda Y, et al. Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer. PLoS ONE. 2021;16(5):e0248871.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu Y, Zhang Z, Chen Y. Prognostic value of pretreatment systemic immune-inflammation index in gastric cancer: a meta-analysis. Front Oncol. 2021;11:537140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang J, Li Q, Xu N, et al. Systemic inflammation biomarkers can identify high tumor mutation burden in lung adenocarcinoma. BMC Cancer. 2025;25:1543.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRapapa KA, Deng Y, Peng Y, et al. The association and clinical significance of hematological biomarkers in ankylosing spondylitis. Sci Rep. 2025;15(1):15755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Shen Y, Dai SY. Research on the significance of blood cells and their derived parameters in endometriosis[J]. Int J Lab Med. 2021;42(5):598\u0026ndash;603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabatabaei F, Tahernia H, Ghaedi A, et al. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health. 2023;23:576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen G, Bao B, Ye Y, et al. Prognostic value of the systemic immune-inflammation index in non-small cell lung cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Front Oncol. 2025;15:1532343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRefaat L, EissaM S, Elnaggar GN, et al. Systemic inflammatory indices comprising monocytes provide a clinical significance for thyroid cancer identification[J/OL]. Sci Rep. 2025;15(1):39967.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, An R, Wang G. Integrating inflammatory biomarkers and demographic variables with machine learning to predict endometriosis risk[J]. Sci Rep. 2025;15(1):42415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan Q, Shi G, Zhao RH. Clinical application value of serum CA-125 in endometriosis. Chin J Clin Obstet Gynecol. 2019;20(1):94\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu Y, Liu LL. Value of combined detection of serum carbohydrate antigen 125, human epididymis protein 4 and neutrophil-to-lymphocyte ratio in the clinical diagnosis of endometriosis. Matern Child Health Care China. 2024;39(17):3296\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe predictive diagnostic. value of combined serum detection of CXCL12, VEGF, and CA125 for endometriosis. Med (Baltim). 2025;104(12):e41436.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian Z, Chang XH, Zhao Y, et al. Current biomarkers for the detection of endometriosis. Chin Med J. 2020;133(19):2346\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNisenblat V, Bossuyt PM, Shaikh R, et al. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2016(5):CD012179.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrungu S, Mavrelos D, Worthington J, et al. Discovery of non-invasive biomarkers for the diagnosis of endometriosis. Clin Proteomics. 2019;16:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrulport A, Bourdon M, Vaiman D, et al. An integrated multi-tissue approach for endometriosis candidate biomarkers: a systematic review. Reprod Biol Endocrinol. 2024;22:21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibbons T, Rahmioglu N, Zondervan KT, et al. Crimson clues: advancing endometriosis detection and management with novel blood biomarkers. Fertil Steril. 2024;121(1):145\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Systemic inflammatory indices, CA-125, Endometriosis","lastPublishedDoi":"10.21203/rs.3.rs-10484565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-10484565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo investigate the expression and clinical significance of systemic inflammatory indices and serum CA-125 in endometriosis, and to compare their diagnostic efficacy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eClinical data were collected from 252 patients with endometriosis (endometriosis group), 214 patients with endometriosis combined with adenomyosis (endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group), and 97 patients with benign ovarian tumors confirmed by postoperative histopathology (control group) treated at Fujian Provincial Maternity and Child Health Hospital from December 2021 to May 2024. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and other systemic inflammatory indices as well as serum CA-125 levels were compared among the three groups. Their expression and diagnostic utility for adenomyosis and endometriosis were evaluated. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of these markers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCA-125, PLR, and dNLR were significantly higher in the endometriosis\u0026thinsp;+\u0026thinsp;adenomyosis group than in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CA-125 and dNLR were significantly higher, while BLR was significantly lower in the endometriosis group compared with the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Serum CA-125 levels were significantly higher in patients with dysmenorrhea than in those without (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The optimal cutoff value of CA-125 for diagnosing endometriosis was 26.85, with a sensitivity of 79.6%, specificity of 82.9%, and Youden index of 0.625.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSerum CA-125 can serve as a serum biomarker for the auxiliary diagnosis of endometriosis, and its diagnostic efficacy is superior to that of systemic inflammatory indices.\u003c/p\u003e","manuscriptTitle":"Systemic inflammatory indices and CA-125 in Endometriosis: Expression and Clinical Significance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-08-10 05:39:23","doi":"10.21203/rs.3.rs-10484565/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-08-04T16:10:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-08-04T16:02:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-08-04T13:07:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-08-04T04:40:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-08-03T12:20:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b4176fa-8c54-431d-946c-fc14eb260c76","owner":[],"postedDate":"August 10th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"5","date":"2026-08-04T16:10:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-08-04T16:02:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-08-04T13:07:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-08-04T04:40:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-08-03T12:20:09+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-08-10T05:39:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-08-10 05:39:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-10484565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-10484565","identity":"rs-10484565","version":["v1"]},"buildId":"niEcNJNr4ZoRKMpLwKGLP","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}