Expression and clinical significance of WBC, hs-CRP, and ROMA index, and tumor markers in endometriosis

Jiao Li, Li J, Kangying Wang, Kuncheng Wang, Wang K
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04749-9 · PMID:42947085 · PMC13715245 · W7171997574
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Endometriosis patients exhibited elevated white blood cell counts, hs-CRP, CA125, HE4, and formula-derived ROMA index values compared to controls, suggesting systemic inflammation and potential diagnostic utility.

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This retrospective study compared preoperative blood biomarkers in 125 women with surgically and histologically confirmed endometriosis and 80 controls without clinical or ultrasonographic evidence of the disease. Endometriosis was associated with significantly higher WBC count, hs-CRP, CA125, HE4, and formula-derived premenopausal and postmenopausal ROMA index values, with no significant differences according to surgical procedure. The authors noted that menopausal status was inconsistently available, so ROMA values were exploratory rather than patient-specific clinical classifications, and HE4 was considered a nonspecific tumor-associated biomarker. This paper is centrally about endometriosis — evaluating inflammatory and tumor-associated biomarkers and ROMA index values in affected patients.

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Abstract

PURPOSE: To investigate the expression and clinical significance of white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), Risk of Ovarian Malignancy Algorithm (ROMA) index, and tumor markers in patients with endometriosis. METHODS: A total of 125 women with surgically and histologically confirmed endometriosis and 80 control women without clinical or ultrasonographic evidence of endometriosis were enrolled at the Affiliated Hospital of Putian University between August 2019 and March 2023. Fasting venous blood samples were collected preoperatively, prior to surgical intervention, to measure WBC, hs-CRP, CA125, HE4, and formula-derived ROMA index values. Statistical analyses included independent-sample t-tests and one-way ANOVA to compare biomarker levels between groups and across surgical procedures. RESULTS: Compared with controls, patients with endometriosis showed significantly elevated WBC, hs-CRP, CA125, HE4, and formula-derived premenopausal and postmenopausal ROMA index values (all p < 0.001). One-way ANOVA showed no significant differences in biomarker levels across surgical procedures. These findings suggest that inflammatory markers, tumor-associated biomarkers, and formula-derived ROMA values are elevated in patients with endometriosis; however, ROMA findings should be interpreted cautiously because menopausal status was not consistently available for patient-specific ROMA classification. CONCLUSION: Elevated WBC count, hs-CRP, CA125, and formula-derived ROMA index values may reflect systemic inflammatory activation in endometriosis, while HE4 should be interpreted more cautiously as a nonspecific tumor-associated biomarker difference. Because menopausal status was not consistently available, ROMA findings should be interpreted as exploratory formula-derived values rather than patient-specific clinical ROMA classifications.
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Abstract

Purpose To investigate the expression and clinical significance of white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), Risk of Ovarian Malignancy Algorithm (ROMA) index, and tumor markers in patients with endometriosis.

Methods

A total of 125 women with surgically and histologically confirmed endometriosis and 80 control women without clinical or ultrasonographic evidence of endometriosis were enrolled at the Affiliated Hospital of Putian University between August 2019 and March 2023. Fasting venous blood samples were collected preoperatively, prior to surgical intervention, to measure WBC, hs-CRP, CA125, HE4, and formula-derived ROMA index values. Statistical analyses included independent-sample t-tests and one-way ANOVA to compare biomarker levels between groups and across surgical procedures.

Results

Compared with controls, patients with endometriosis showed significantly elevated WBC, hs-CRP, CA125, HE4, and formula-derived premenopausal and postmenopausal ROMA index values (all p < 0.001). One-way ANOVA showed no significant differences in biomarker levels across surgical procedures. These findings suggest that inflammatory markers, tumor-associated biomarkers, and formula-derived ROMA values are elevated in patients with endometriosis; however, ROMA findings should be interpreted cautiously because menopausal status was not consistently available for patient-specific ROMA classification.

Conclusion

Elevated WBC count, hs-CRP, CA125, and formula-derived ROMA index values may reflect systemic inflammatory activation in endometriosis, while HE4 should be interpreted more cautiously as a nonspecific tumor-associated biomarker difference. Because menopausal status was not consistently available, ROMA findings should be interpreted as exploratory formula-derived values rather than patient-specific clinical ROMA classifications.

Acknowledgements

The authors sincerely thank the clinical and laboratory staff of the Affiliated Hospital of Putian University for their assistance in sample collection, data recording, and technical support. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This retrospective study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Putian University for the analysis and reporting of existing clinical and laboratory data from patients treated between August 2019 and March 2023 (Approval No. 2025119). The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent for the use of clinical data was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Li, J., Wang, K. Expression and clinical significance of WBC, hs-CRP, and ROMA index, and tumor markers in endometriosis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04749-9 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04749-9

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MeSH descriptors

Biomarkers, Tumor Biomarkers, Tumor Biomarkers, Tumor C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein Endometriosis Endometriosis Endometriosis Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Adult Adult Algorithms Algorithms CA-125 Antigen CA-125 Antigen

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