Preoperative Clinical and Hematological Parameters in the Differential Diagnosis of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) and Leiomyoma: A Retrospective Study

Preoperative Clinical and Hematological Parameters in the Differential Diagnosis of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) and Leiomyoma: A Retrospective Study | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative Clinical and Hematological Parameters in the Differential Diagnosis of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) and Leiomyoma: A Retrospective Study Ahmet Tezcanlar¹, Hale Cetin Arslan², Sureyya Tuba Fettahoglu³, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7577395/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Purpose Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are a rare tumor group that falls between benign and malignant uterine smooth muscle tumors. Our study aimed to compare the preoperative characteristics of patients diagnosed with STUMP and leiomyoma and to determine parameters that can be used in differential diagnosis. Material and Method: This retrospective, cross-sectional study included 73 patients who underwent surgery between 2015 and 2023 with a preliminary diagnosis of uterine myoma and whose final pathology results were either STUMP (n = 32) or leiomyoma (n = 41). Demographic data, tumor characteristics, surgical procedures, biochemical (CA-125, LDH), and hematological parameters (hemogram, NLR, MLR, PLR, SII, SIRI) were compared. Results STUMP patients were more frequently seen at an older age (p = 0.040) and in the postmenopausal period (p < 0.001) compared to the leiomyoma group. Serum LDH levels were significantly higher in the STUMP group (p = 0.017). Lymphocyte count was higher in the STUMP group (p < 0.005), and PLR was higher in the leiomyoma group (p = 0.003). There were no significant differences in NLR, MLR, SIRI, and SII. Conclusion Serum LDH levels, lymphocyte counts, and PLR values ​​may be potential biomarkers for distinguishing STUMP from leiomyoma. These simple and accessible tests may contribute to preoperative clinical decision-making. Smooth muscle tumor of uncertain malignant potential (STUMP) leiomyoma lactate dehydrogenase (LDH) platelet-to-lymphocyte ratio (PLR) systemic inflammatory response index (SIRI) Figures Figure 1 Introduction Uterine smooth muscle tumors are the most common gynecologic neoplasms in women, the majority of which are benign leiomyomas [ 1 ]. Among the malignant forms, leiomyosarcoma is the most common subtype [ 2 ]. The basic histopathological criteria for distinguishing benign from malignant tumors are cellular atypia, mitotic index, and tumor cell necrosis. However, some tumors do not meet the strict definitions of benign or malignant by these criteria, exhibiting intermediate characteristics. Therefore, the World Health Organization (WHO) defined the term "smooth muscle tumor of uncertain malignant potential (STUMP)" in 2003. STUMPs are a morphologically heterogeneous group of tumors that do not fully meet the criteria for leiomyoma or leiomyosarcoma [ 3 ]. These tumors exhibit various combinations of cytologic atypia, mitotic index, and tumor cell necrosis [ 4 ]. Diagnosis is usually made by postoperative histopathologic evaluation of hysterectomy or myomectomy specimens. However, there is no definitive consensus in the literature regarding diagnosis, treatment, and follow-up. Although clinically mostly benign, STUMP cases have been reported to develop recurrence or metastasis. Recurrence rates in the literature range from 8.7% to 11%, and the histology of recurrence can be either STUMP or leiomyosarcoma [ 5 ]. Therefore, STUMP is considered a tumor with low malignant potential. The clinical features of STUMP are mainly similar to those of leiomyoma and leiomyosarcoma [ 6 ]. Currently, no imaging or laboratory method can reliably distinguish these lesions. The treatment approach depends on estrogen receptor status, patient age, and the presence of metastatic disease; whether or not the ovaries are removed during surgical resection is determined by these factors [ 7 ]. Inflammatory markers, such as lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI), aid in predicting disease prognosis in various malignancies [ 8 – 11 ]. However, reliable biomarkers that can distinguish STUMP from leiomyoma preoperatively are limited. Routine imaging and clinical parameters cannot distinguish the disease, and therefore, hematologic and biochemical markers have emerged as potential differential parameters in recent years. This study aims to retrospectively compare the preoperative clinical, hematological, and biochemical features of patients diagnosed with STUMP and leiomyoma as a result of pathology in our clinic and to reveal potential parameters that can be used in differential diagnosis. Materials and method This study was initiated with approval from the Clinical Research Ethics Committee of the Istanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences (KAEK/2023.12.78, date: 20.03.2024) and conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants included in this study. This retrospective, cross-sectional study included patients who underwent surgery at our clinic between January 2015 and December 2023 with a preliminary diagnosis of uterine myoma and were diagnosed with STUMP or leiomyoma on final pathology. Inclusion criteria: (1) being between 25 and 75 years of age, (2) having a final pathology diagnosis of STUMP or leiomyoma. Exclusion criteria: (1) being 75 years of age, (2) having a diagnosis other than STUMP or leiomyoma on pathology, and (3) having incomplete clinical data. Patient demographics (age, BMI, gravida, parity, menopausal status, smoking status), tumor size and location, surgical procedure performed, and need for follow-up surgery were recorded. Serum CA-125 (U/mL), LDH (U/L), hemoglobin, hematocrit, leukocyte, platelet, erythrocyte, monocyte, neutrophil, and lymphocyte values ​​obtained from preoperative peripheral blood samples, and inflammatory indices derived from these values ​​(NLR, MLR, PLR, SII, SIRI) were also evaluated. The postoperative follow-up time (in years) was also recorded. Sample size was calculated using G*Power 3.1.9.2. Assuming an effect size of 0.5 for the chi-square test, a type I error level of α = 0.05, power (1-β) = 0.80, and degrees of freedom of 2, the minimum sample size for each group was 32. The calculation was based on the method of Lanqing Huo et al. The study, published in 2020, was used as a reference [ 12 ]. Ultimately, a total of 73 cases were analyzed, including 32 patients in the STUMP group (Group S) and 41 patients in the leiomyoma group (Group L) (Fig. 1 ). Statistical analysis Data were analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics for continuous variables are presented as mean ± standard deviation, median, minimum, and maximum values, while categorical variables are presented as frequencies and percentages. Normality of the distribution was assessed using the Shapiro–Wilk test and a histogram. Variables with normal distribution were compared using the independent samples t-test, and variables without normal distribution were compared using the Mann–Whitney U test. The chi-square test was used for analysis of categorical variables. Statistical significance was considered significant if p < 0.05. Results A total of 73 patients were included in the study and were retrospectively analyzed. The mean age of the patients was 43.9 ± 7.8 years, and the mean BMI was 29.5 ± 5.3 kg/m². The mean tumor diameter was 6.5 ± 2.9 cm, and the mean follow-up time was 3.6 ± 2.5 years. Serum CA-125 and LDH levels were 23.2 ± 20.9 U/mL and 183.2 ± 29.8 U/L, respectively. 31.5% of the patients were in menopause, and 41.1% were active smokers. Based on the final pathology, the patients were divided into two groups: STUMP (Group S, n = 32) and leiomyoma (Group L, n = 41). The mean age of the patients in Group S was significantly higher (45.9 ± 8.2 years vs. 41.3 ± 7.2 years; p = 0.040). The menopause rate was significantly higher in Group S (59.4% vs. 9.8%; p < 0.001). The follow-up period was longer in Group S (4.6 ± 3.2 vs. 2.7 ± 1.2 years; p = 0.027). No difference was observed between the two groups in terms of BMI, gravida, parity, tumor diameter, and CA-125 values. Serum LDH level was significantly higher in Group S (191.6 ± 26.3 vs. 176.7 ± 31.1 U/L; p = 0.017) (Table 1 ). Table 1 Comparative Analysis of Characteristic Features of Groups All population Group S (n = 32) Group L (n = 41) P value Mean ± SD Mean ± SD Mean ± SD Age (years) 43,87 7,84 45,90 8,22 41,29 7,24 0.040 BMI (kg/m²) 29,52 5,29 28,95 4,32 29,97 5,96 0.419 Gravida 2,36 1,62 2,71 1,72 2,09 1,51 0.207 Parity 1,97 1,35 2,18 1,22 1,80 1,43 0.311 Tumor diameter (cm) 6,51 2,90 6,28 2,78 6,69 3,01 0.598 Follow-up period (years) 3,56 2,48 4,62 3,24 2,73 1,18 0.027 Serum CA-125 (U/mL) 23,17 20,86 20,90 15,42 24,95 24,33 0.656 Serum LDH (U/L) 183,24 29,81 191,59 26,27 176,73 31,08 0.017 Menopause (n,%) 23 31,5 19 59,4 4 9,8 < 0,001 Smoker (n,%) 30 41,1 13 40,6 17 41,5 0.942 (Values ​​are expressed as mean ± standard deviation.) (BMI, body mass index; LDH, lactate dehydrogenase; SD, Standard Deviation; CA, Cancer Antigen) No significant difference was found between the two groups in terms of tumor location (p > 0.05). However, when surgical procedures were evaluated, abdominal hysterectomy (34.4%) and laparoscopic hysterectomy (15.6%) were performed more frequently in Group S. In contrast, the most common surgical method in Group L was myomectomy via laparotomy (70.7%) (p < 0.05). Additionally, 25% of Group S patients underwent an additional surgical procedure (hysterectomy), whereas Group L patients did not require additional surgery (p < 0.001) (Table 2 ). Table 2 Localization of tumors and distribution of surgical procedures performed between groups. Group S (n = 32) Group L (n = 41) P -value n % n % Tumor localization Fundus 8 25 8 19,5 0.574 Anterior 7 21,9 12 29,3 0.475 Posterior 10 31,3 13 31,7 0.967 Vaginal 2 6,3 3 7,3 1.000* Intracavitary 5 15,6 5 12,2 0.740* Surgical procedure Vaginal Myomectomy 1 3,1 6 14,6 0.127* Myomectomy with Laparotomy 13 40,6 29 70,7 0.010 Laparoscopic Myomectomy 1 3,1 4 9,8 0.377* Abdominal Hysterectomy 11 34,4 - - < 0.001 Laparoscopic Hysterectomy 5 15,6 - - 0.013 Operative Hysteroscopy 1 3,1 2 4,9 1.000* Additional surgical procedure 8 25 - - < 0.001 (Values ​​are expressed as numbers and percentages.) (Pearson chi-square test was used.) (* Fisher's exact test was used.) When hematological parameters were examined, no significant differences were found between the two groups in terms of hemoglobin, hematocrit, leukocyte, platelet, erythrocyte, monocyte, and neutrophil values. However, the lymphocyte count was significantly higher in Group S patients (2.29 ± 0.60 vs. 1.91 ± 0.53 ×10³/µL; p < 0.005). In contrast, the PLR ​​value was significantly higher in Group L patients (175.2 ± 87.5 vs. 133.5 ± 53.4; p = 0.003). No significant differences were observed between the groups in terms of NLR, MLR, SIRI, and SII values ​​(Table 3 ). Table 3 Intergroup Comparative Analysis of Hematological and Inflammatory Parameters Between Groups Group S (n = 32) Group L (n = 41) P -value Mean ± SD Mean ± SD Hemoglobin (g/dL) 11,43 1,96 11,54 1,80 0.801 Hematocrit (%) 35,42 5,09 35,34 4,36 0.940 Leukocyte (mm³×10³) 7,97 1,70 7,97 3,33 0.391 Platelet (×10³/µL) 286,62 79,94 306,31 85,32 0.318 Erythrocyte (×10³/µL) 4,42 0,42 4,23 0,43 0.074 Monocyte (×10³/µL) 0,52 0,15 0,49 0,21 0.088 Neutrophil (×10³/µL) 5,02 1,80 5,47 3,49 0.907 Lymphocyte (×10³/µL) 2,29 0,60 1,91 0,53 < 0.005* MLR 0,24 0,13 0,29 0,26 0.353 NLR 2,65 2,85 3,77 5,57 0.186 PLR 133,50 53,44 175,20 87,49 0.003 SIRI 1,39 1,51 2,25 5,39 0.613 SII 700,91 589,57 1161,48 1811,45 0.085 (Values ​​are expressed as mean ± standard deviation.) (MLR: Monocyte/lymphocyte ratio; NLR: Neutrophil/lymphocyte ratio, PLR: Platelet/lymphocyte ratio; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index.) (Mann-Whitney U test was used.) (*Independent samples t-test was used.) Discussion This study compared STUMP and leiomyoma cases in terms of preoperative clinical, biochemical, and hematological parameters. Our findings indicate that STUMP patients are more frequently seen in older and postmenopausal patients, have significantly higher serum LDH levels, and have higher lymphocyte counts compared to leiomyoma patients. In contrast, PLR values ​​were significantly higher in the leiomyoma group. No significant differences were found between the groups in terms of tumor diameter or serum CA-125 levels. The significantly higher postmenopausal rate in the STUMP group (59.4%; p < 0.001) partially contradicts studies in the literature indicating that STUMP is most often diagnosed in the perimenopausal period [ 13 , 14 ]. The higher postmenopausal rate in our series may be related to differences in patient age at presentation, surgical indication criteria, and referral patterns specific to our center. Conversely, the higher incidence of leiomyomas in the reproductive period is consistent with the lower postmenopausal rate in this group. Overweight and obesity are known to be risk factors for leiomyoma [ 15 , 16 ]. However, studies examining the relationship between STUMP and BMI have not demonstrated a significant association [ 17 , 18 ]. In our cohort, the mean BMI of STUMP patients was 28.98 ± 4.32 kg/m², consistent with findings in the literature. No significant difference was found between the groups in terms of BMI (p = 0.419). No significant differences were found between the groups in terms of parity and gravida. Although there is strong evidence that parity reduces the risk of developing leiomyoma [ 19 , 20 ], the relationship between parity and STUMP remains unclear. Some studies in the literature, in line with our findings, report no significant association between parity and STUMP [ 18 , 21 ]. Among biochemical markers, LDH was one of the most prominent parameters in the distinction between STUMP and leiomyoma. In our study, LDH levels were found to be significantly higher in the STUMP group (191.59 ± 26.27 vs. 176.73 ± 31.08 U/L; p = 0.017). Increased LDH is associated with increased cellular turnover and tumor necrosis and is considered an indicator of malignant potential [ 22 ]. Suh et al. found significantly higher LDH levels (425.0 U/L) in leiomyosarcoma cases, whereas this value was 185.5 U/L in the leiomyoma group, and the difference was statistically significant (p < 0.001) [ 23 ]. Similarly, Akbarzadeh et al. reported that LDH levels were elevated in tumors with malignant potential [ 24 ]. Our findings, although not as clear as the distinction between LMS and leiomyoma, suggest that LDH may be a clinically useful indicator in the preoperative period for distinguishing between STUMP and leiomyoma. In terms of surgical management, the need for additional surgery after myomectomy was found to be 25% (8/32) in the STUMP group in our study, a rate consistent with the range of 21.5–43% reported in the literature [ 17 , 18 , 25 ]. Borella et al. reported higher rates in their study, which is explained by the higher proportion of premenopausal patients in their group and the more frequent choice of fertility-sparing surgery [ 17 ]. The higher proportion of postmenopausal patients in our series may have contributed to the use of more radical surgical approaches in the initial surgery, thus reducing the need for a second surgery. Tumor size was not a decisive parameter in distinguishing between the STUMP and leiomyoma groups. In our series, the mean tumor size in both groups was similar (6.28 cm vs. 6.69 cm; p = 0.598). A wide range of tumor size is also reported in the literature (5.5–13 cm) (26–28). These differences are thought to be related to the limited number of cases, variations in patient presentation time, and differences in tumor growth rates. Our findings support the limited diagnostic value of tumor size alone in distinguishing STUMP from leiomyoma. Serum CA-125 levels were similar between the groups (p = 0.656). This marker often increases in association with peritoneal irritation, coexisting pathologies, or tumor burden [ 12 , 24 , 29 ]. Therefore, the lack of a significant difference between STUMP and leiomyoma is an expected finding and is consistent with previous studies [ 18 , 21 , 25 ]. Among hematological parameters, lymphocyte count was significantly higher in the STUMP group (p < 0.005), while PLR ​​was higher in the leiomyoma group (p = 0.003). No significant differences were found for NLR, MLR, SIRI, and SII. Findings in the literature regarding the prognostic and diagnostic value of lymphocyte counts and derived ratios in gynecologic malignancies are contradictory: some studies report lower lymphocyte counts in the malignant group [ 30 ], while others report stage-related differences [ 31 – 33 ]. In our series, the higher PLR in the leiomyoma group suggests that STUMP does not exhibit a significant preoperative inflammatory burden. However, prospective, large-scale studies are needed to confirm this result. Limitations The primary limitations of this study are its retrospective design, single-center nature, and limited sample size. Potential confounding factors such as sampling time, concomitant inflammatory conditions, and medication use were not fully controlled for in the assessment of hematologic markers. Furthermore, subgroup analyses based on histologic subtypes of STUMP were not performed. Conclusion Our study demonstrated that STUMP is more common in older age groups and during the postmenopausal period. Serum LDH levels and lymphocyte/PLR profiles may be potential biomarkers for distinguishing STUMP from leiomyoma. While other inflammatory parameters, such as NLR and MLR, did not show significant differences in our study, they have been reported to be associated with some malignancies in the literature. Therefore, prospective studies with large samples are needed to elucidate the diagnostic value of inflammatory markers in uterine smooth muscle tumors. While these parameters are not diagnostic alone, they can contribute to risk stratification when used in conjunction with clinical and imaging findings. Furthermore, their ease of use and low cost offer practical support for differential diagnosis in the preoperative period. Declarations Ethics Approval : This study was approved by the Ethics Committee of the Istanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences (KAEK/2023.12.78, date: 20.03.2024). Clinical Trial Registrati on Not applicable. Clinical trial number Not applicable. Human Ethics and Consent to Participate All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee. Written informed consent was obtained from all individual participants included in the study. Funding: This research received no external funding. Author Contribution A.T.: Preparation of tables, manuscript editing, and development of visual materials H.C.A.: Conceptualization, methodology development, data analysis, writing—original draft and editing.S.T.F.: Preparation of tables, manuscript editing, and development of visual materials. S.F.: Evaluation criteria design, coordination of the assessment process, and content validity analysis. I.T.Y.: Literature review, reference validation, interpretation of findings, and final manuscript review. All authors have read and agreed to the published version of the manuscript. Data Availability The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request. References Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36(4):433-445 Devaud N, Vornicova O, Abdul Razak AR, et al (2022) Leiomyosarcoma: Current Clinical Management and Future Horizons. Surg Oncol Clin N Am 31(3):527-546 Guntupalli SR, Ramirez PT, Anderson ML, Milam MR, Bodurka DC, Malpica A (2009) Uterine smooth muscle tumor of uncertain malignant potential: a retrospective analysis. Gynecol Oncol 113(3):324-326. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-7577395","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522807141,"identity":"b12976d7-981e-42e0-b68a-aa0703218870","order_by":0,"name":"Ahmet Tezcanlar¹","email":"","orcid":"","institution":"Araban District State Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"","lastName":"Tezcanlar¹","suffix":""},{"id":522807142,"identity":"0cac8d43-8f40-4786-85db-2adba8f105ac","order_by":1,"name":"Hale Cetin 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sureyya","middleName":"Tuba","lastName":"Fettahoglu³","suffix":""},{"id":522807144,"identity":"fc7e4548-630f-4782-b002-b5395fcaeea8","order_by":3,"name":"Salih Fettahoglu⁴","email":"","orcid":"","institution":"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Salih","middleName":"","lastName":"Fettahoglu⁴","suffix":""},{"id":522807145,"identity":"da6e6ddd-b7a8-400e-9c23-ca188f06df5a","order_by":4,"name":"İlkbal Temel Yüksel⁵","email":"","orcid":"","institution":"University of Health Sciences, Basaksehir Cam and Sakura City Hospital","correspondingAuthor":false,"prefix":"","firstName":"İlkbal","middleName":"Temel","lastName":"Yüksel⁵","suffix":""}],"badges":[],"createdAt":"2025-09-09 23:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7577395/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7577395/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92679920,"identity":"7b0cfc32-5403-4072-91f4-9d507c7835f1","added_by":"auto","created_at":"2025-10-03 01:01:38","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39398,"visible":true,"origin":"","legend":"","description":"","filename":"flowchart.docx","url":"https://assets-eu.researchsquare.com/files/rs-7577395/v1/de799ecac9de4b846249086b.docx"},{"id":92679924,"identity":"b0f4b789-becd-4b89-b497-7331b23257ea","added_by":"auto","created_at":"2025-10-03 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01:01:38","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111695,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7577395/v1/4eba92edbf1c3ab3212d69b0.html"},{"id":92681502,"identity":"fabdcd9c-5ed7-4fd6-ad47-6f8115fa72be","added_by":"auto","created_at":"2025-10-03 01:09:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46318,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the study population.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7577395/v1/764c8ef2013a31b2c83c6f05.png"},{"id":92681549,"identity":"12a04242-3331-49be-ae70-d323634fc8d1","added_by":"auto","created_at":"2025-10-03 01:09:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":879773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7577395/v1/2bdb6dcc-a403-46b8-9ceb-43fae51f0ca9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preoperative Clinical and Hematological Parameters in the Differential Diagnosis of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) and Leiomyoma: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine smooth muscle tumors are the most common gynecologic neoplasms in women, the majority of which are benign leiomyomas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among the malignant forms, leiomyosarcoma is the most common subtype [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The basic histopathological criteria for distinguishing benign from malignant tumors are cellular atypia, mitotic index, and tumor cell necrosis. However, some tumors do not meet the strict definitions of benign or malignant by these criteria, exhibiting intermediate characteristics.\u003c/p\u003e\u003cp\u003eTherefore, the World Health Organization (WHO) defined the term \"smooth muscle tumor of uncertain malignant potential (STUMP)\" in 2003. STUMPs are a morphologically heterogeneous group of tumors that do not fully meet the criteria for leiomyoma or leiomyosarcoma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These tumors exhibit various combinations of cytologic atypia, mitotic index, and tumor cell necrosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Diagnosis is usually made by postoperative histopathologic evaluation of hysterectomy or myomectomy specimens. However, there is no definitive consensus in the literature regarding diagnosis, treatment, and follow-up.\u003c/p\u003e\u003cp\u003eAlthough clinically mostly benign, STUMP cases have been reported to develop recurrence or metastasis. Recurrence rates in the literature range from 8.7% to 11%, and the histology of recurrence can be either STUMP or leiomyosarcoma [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, STUMP is considered a tumor with low malignant potential.\u003c/p\u003e\u003cp\u003eThe clinical features of STUMP are mainly similar to those of leiomyoma and leiomyosarcoma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Currently, no imaging or laboratory method can reliably distinguish these lesions. The treatment approach depends on estrogen receptor status, patient age, and the presence of metastatic disease; whether or not the ovaries are removed during surgical resection is determined by these factors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInflammatory markers, such as lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI), aid in predicting disease prognosis in various malignancies [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, reliable biomarkers that can distinguish STUMP from leiomyoma preoperatively are limited. Routine imaging and clinical parameters cannot distinguish the disease, and therefore, hematologic and biochemical markers have emerged as potential differential parameters in recent years.\u003c/p\u003e\u003cp\u003eThis study aims to retrospectively compare the preoperative clinical, hematological, and biochemical features of patients diagnosed with STUMP and leiomyoma as a result of pathology in our clinic and to reveal potential parameters that can be used in differential diagnosis.\u003c/p\u003e"},{"header":"Materials and method","content":"\u003cp\u003e This study was initiated with approval from the Clinical Research Ethics Committee of the Istanbul Kanuni Sultan S\u0026uuml;leyman Training and Research Hospital, University of Health Sciences (KAEK/2023.12.78, date: 20.03.2024) and conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants included in this study.\u003c/p\u003e\u003cp\u003eThis retrospective, cross-sectional study included patients who underwent surgery at our clinic between January 2015 and December 2023 with a preliminary diagnosis of uterine myoma and were diagnosed with STUMP or leiomyoma on final pathology.\u003c/p\u003e\u003cp\u003eInclusion criteria: (1) being between 25 and 75 years of age, (2) having a final pathology diagnosis of STUMP or leiomyoma. Exclusion criteria: (1) being \u0026lt;\u0026thinsp;25 or \u0026gt;\u0026thinsp;75 years of age, (2) having a diagnosis other than STUMP or leiomyoma on pathology, and (3) having incomplete clinical data.\u003c/p\u003e\u003cp\u003ePatient demographics (age, BMI, gravida, parity, menopausal status, smoking status), tumor size and location, surgical procedure performed, and need for follow-up surgery were recorded. Serum CA-125 (U/mL), LDH (U/L), hemoglobin, hematocrit, leukocyte, platelet, erythrocyte, monocyte, neutrophil, and lymphocyte values ​​obtained from preoperative peripheral blood samples, and inflammatory indices derived from these values ​​(NLR, MLR, PLR, SII, SIRI) were also evaluated. The postoperative follow-up time (in years) was also recorded.\u003c/p\u003e\u003cp\u003eSample size was calculated using G*Power 3.1.9.2. Assuming an effect size of 0.5 for the chi-square test, a type I error level of α\u0026thinsp;=\u0026thinsp;0.05, power (1-β)\u0026thinsp;=\u0026thinsp;0.80, and degrees of freedom of 2, the minimum sample size for each group was 32. The calculation was based on the method of Lanqing Huo et al. The study, published in 2020, was used as a reference [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Ultimately, a total of 73 cases were analyzed, including 32 patients in the STUMP group (Group S) and 41 patients in the leiomyoma group (Group L) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics for continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median, minimum, and maximum values, while categorical variables are presented as frequencies and percentages. Normality of the distribution was assessed using the Shapiro\u0026ndash;Wilk test and a histogram. Variables with normal distribution were compared using the independent samples t-test, and variables without normal distribution were compared using the Mann\u0026ndash;Whitney U test. The chi-square test was used for analysis of categorical variables. Statistical significance was considered significant if p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 73 patients were included in the study and were retrospectively analyzed. The mean age of the patients was 43.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 years, and the mean BMI was 29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 kg/m\u0026sup2;. The mean tumor diameter was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 cm, and the mean follow-up time was 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 years. Serum CA-125 and LDH levels were 23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.9 U/mL and 183.2\u0026thinsp;\u0026plusmn;\u0026thinsp;29.8 U/L, respectively. 31.5% of the patients were in menopause, and 41.1% were active smokers. Based on the final pathology, the patients were divided into two groups: STUMP (Group S, n\u0026thinsp;=\u0026thinsp;32) and leiomyoma (Group L, n\u0026thinsp;=\u0026thinsp;41). The mean age of the patients in Group S was significantly higher (45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 years vs. 41.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years; p\u0026thinsp;=\u0026thinsp;0.040). The menopause rate was significantly higher in Group S (59.4% vs. 9.8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The follow-up period was longer in Group S (4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 vs. 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 years; p\u0026thinsp;=\u0026thinsp;0.027). No difference was observed between the two groups in terms of BMI, gravida, parity, tumor diameter, and CA-125 values. Serum LDH level was significantly higher in Group S (191.6\u0026thinsp;\u0026plusmn;\u0026thinsp;26.3 vs. 176.7\u0026thinsp;\u0026plusmn;\u0026thinsp;31.1 U/L; p\u0026thinsp;=\u0026thinsp;0.017) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eComparative Analysis of Characteristic Features of Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAll population\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGroup S (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eGroup L (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43,87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7,84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45,90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e41,29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29,52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5,29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28,95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4,32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e29,97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e5,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravida\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2,36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2,71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2,09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1,51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1,97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2,18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1,43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor diameter (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6,51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6,28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2,78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6,69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3,01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFollow-up period (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3,56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4,62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2,73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1,18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum CA-125 (U/mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20,86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20,90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24,95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e24,33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum LDH (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29,81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e191,59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26,27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e176,73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e31,08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMenopause (n,%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31,5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e59,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoker (n,%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e41,5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e(Values ​​are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e(BMI, body mass index; LDH, lactate dehydrogenase; SD, Standard Deviation; CA, Cancer Antigen)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNo significant difference was found between the two groups in terms of tumor location (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, when surgical procedures were evaluated, abdominal hysterectomy (34.4%) and laparoscopic hysterectomy (15.6%) were performed more frequently in Group S. In contrast, the most common surgical method in Group L was myomectomy via laparotomy (70.7%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, 25% of Group S patients underwent an additional surgical procedure (hysterectomy), whereas Group L patients did not require additional surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLocalization of tumors and distribution of surgical procedures performed between 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=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup S (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGroup L (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e -value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor localization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFundus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19,5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.574\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.475\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosterior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracavitary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12,2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.740*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal Myomectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.127*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMyomectomy with Laparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaparoscopic Myomectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.377*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Hysterectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaparoscopic Hysterectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative Hysteroscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdditional surgical procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e(Values ​​are expressed as numbers and percentages.)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e(Pearson chi-square test was used.) (* Fisher's exact test was used.)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen hematological parameters were examined, no significant differences were found between the two groups in terms of hemoglobin, hematocrit, leukocyte, platelet, erythrocyte, monocyte, and neutrophil values. However, the lymphocyte count was significantly higher in Group S patients (2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60 vs. 1.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53 \u0026times;10\u0026sup3;/\u0026micro;L; p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). In contrast, the PLR ​​value was significantly higher in Group L patients (175.2\u0026thinsp;\u0026plusmn;\u0026thinsp;87.5 vs. 133.5\u0026thinsp;\u0026plusmn;\u0026thinsp;53.4; p\u0026thinsp;=\u0026thinsp;0.003). No significant differences were observed between the groups in terms of NLR, MLR, SIRI, and SII values ​​(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\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 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntergroup Comparative Analysis of Hematological and Inflammatory Parameters Between 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=\".\" 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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroup S (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGroup L (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin (g/dL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11,43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11,54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHematocrit (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5,09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35,34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4,36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.940\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeukocyte (mm\u0026sup3;\u0026times;10\u0026sup3;)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7,97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7,97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3,33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlatelet (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e286,62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79,94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e306,31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85,32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eErythrocyte (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4,23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonocyte (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0,52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5,02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5,47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3,49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.907\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLymphocyte (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2,29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.005*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMLR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.353\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2,65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3,77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5,57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e133,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53,44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e175,20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e87,49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSIRI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1,39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2,25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5,39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSII\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e700,91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e589,57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1161,48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1811,45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e(Values ​​are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.) (MLR: Monocyte/lymphocyte ratio; NLR: Neutrophil/lymphocyte ratio, PLR: Platelet/lymphocyte ratio; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index.)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e(Mann-Whitney U test was used.) (*Independent samples t-test was used.)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study compared STUMP and leiomyoma cases in terms of preoperative clinical, biochemical, and hematological parameters. Our findings indicate that STUMP patients are more frequently seen in older and postmenopausal patients, have significantly higher serum LDH levels, and have higher lymphocyte counts compared to leiomyoma patients. In contrast, PLR values ​​were significantly higher in the leiomyoma group. No significant differences were found between the groups in terms of tumor diameter or serum CA-125 levels.\u003c/p\u003e\u003cp\u003eThe significantly higher postmenopausal rate in the STUMP group (59.4%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) partially contradicts studies in the literature indicating that STUMP is most often diagnosed in the perimenopausal period [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The higher postmenopausal rate in our series may be related to differences in patient age at presentation, surgical indication criteria, and referral patterns specific to our center. Conversely, the higher incidence of leiomyomas in the reproductive period is consistent with the lower postmenopausal rate in this group.\u003c/p\u003e\u003cp\u003eOverweight and obesity are known to be risk factors for leiomyoma [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, studies examining the relationship between STUMP and BMI have not demonstrated a significant association [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our cohort, the mean BMI of STUMP patients was 28.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32 kg/m\u0026sup2;, consistent with findings in the literature. No significant difference was found between the groups in terms of BMI (p\u0026thinsp;=\u0026thinsp;0.419).\u003c/p\u003e\u003cp\u003eNo significant differences were found between the groups in terms of parity and gravida. Although there is strong evidence that parity reduces the risk of developing leiomyoma [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the relationship between parity and STUMP remains unclear. Some studies in the literature, in line with our findings, report no significant association between parity and STUMP [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong biochemical markers, LDH was one of the most prominent parameters in the distinction between STUMP and leiomyoma. In our study, LDH levels were found to be significantly higher in the STUMP group (191.59\u0026thinsp;\u0026plusmn;\u0026thinsp;26.27 vs. 176.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.08 U/L; p\u0026thinsp;=\u0026thinsp;0.017). Increased LDH is associated with increased cellular turnover and tumor necrosis and is considered an indicator of malignant potential [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Suh et al. found significantly higher LDH levels (425.0 U/L) in leiomyosarcoma cases, whereas this value was 185.5 U/L in the leiomyoma group, and the difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Similarly, Akbarzadeh et al. reported that LDH levels were elevated in tumors with malignant potential [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our findings, although not as clear as the distinction between LMS and leiomyoma, suggest that LDH may be a clinically useful indicator in the preoperative period for distinguishing between STUMP and leiomyoma.\u003c/p\u003e\u003cp\u003eIn terms of surgical management, the need for additional surgery after myomectomy was found to be 25% (8/32) in the STUMP group in our study, a rate consistent with the range of 21.5\u0026ndash;43% reported in the literature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Borella et al. reported higher rates in their study, which is explained by the higher proportion of premenopausal patients in their group and the more frequent choice of fertility-sparing surgery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The higher proportion of postmenopausal patients in our series may have contributed to the use of more radical surgical approaches in the initial surgery, thus reducing the need for a second surgery.\u003c/p\u003e\u003cp\u003eTumor size was not a decisive parameter in distinguishing between the STUMP and leiomyoma groups. In our series, the mean tumor size in both groups was similar (6.28 cm vs. 6.69 cm; p\u0026thinsp;=\u0026thinsp;0.598). A wide range of tumor size is also reported in the literature (5.5\u0026ndash;13 cm) (26\u0026ndash;28). These differences are thought to be related to the limited number of cases, variations in patient presentation time, and differences in tumor growth rates. Our findings support the limited diagnostic value of tumor size alone in distinguishing STUMP from leiomyoma.\u003c/p\u003e\u003cp\u003eSerum CA-125 levels were similar between the groups (p\u0026thinsp;=\u0026thinsp;0.656). This marker often increases in association with peritoneal irritation, coexisting pathologies, or tumor burden [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Therefore, the lack of a significant difference between STUMP and leiomyoma is an expected finding and is consistent with previous studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong hematological parameters, lymphocyte count was significantly higher in the STUMP group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), while PLR ​​was higher in the leiomyoma group (p\u0026thinsp;=\u0026thinsp;0.003). No significant differences were found for NLR, MLR, SIRI, and SII. Findings in the literature regarding the prognostic and diagnostic value of lymphocyte counts and derived ratios in gynecologic malignancies are contradictory: some studies report lower lymphocyte counts in the malignant group [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], while others report stage-related differences [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In our series, the higher PLR in the leiomyoma group suggests that STUMP does not exhibit a significant preoperative inflammatory burden. However, prospective, large-scale studies are needed to confirm this result.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe primary limitations of this study are its retrospective design, single-center nature, and limited sample size. Potential confounding factors such as sampling time, concomitant inflammatory conditions, and medication use were not fully controlled for in the assessment of hematologic markers. Furthermore, subgroup analyses based on histologic subtypes of STUMP were not performed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study demonstrated that STUMP is more common in older age groups and during the postmenopausal period. Serum LDH levels and lymphocyte/PLR profiles may be potential biomarkers for distinguishing STUMP from leiomyoma. While other inflammatory parameters, such as NLR and MLR, did not show significant differences in our study, they have been reported to be associated with some malignancies in the literature. Therefore, prospective studies with large samples are needed to elucidate the diagnostic value of inflammatory markers in uterine smooth muscle tumors. While these parameters are not diagnostic alone, they can contribute to risk stratification when used in conjunction with clinical and imaging findings. Furthermore, their ease of use and low cost offer practical support for differential diagnosis in the preoperative period.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e:\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Istanbul Kanuni Sultan S\u0026uuml;leyman Training and Research Hospital, University of Health Sciences (KAEK/2023.12.78, date: 20.03.2024).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cstrong\u003eClinical Trial Registrati\u003c/strong\u003eon\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee. Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eA.T.: Preparation of tables, manuscript editing, and development of visual materials H.C.A.: Conceptualization, methodology development, data analysis, writing\u0026mdash;original draft and editing.S.T.F.: Preparation of tables, manuscript editing, and development of visual materials. S.F.: Evaluation criteria design, coordination of the assessment process, and content validity analysis. I.T.Y.: Literature review, reference validation, interpretation of findings, and final manuscript review. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eButtram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36(4):433-445\u003c/li\u003e\n\u003cli\u003eDevaud N, Vornicova O, Abdul Razak AR, et al (2022) Leiomyosarcoma: Current Clinical Management and Future Horizons. Surg Oncol Clin N Am 31(3):527-546 \u003c/li\u003e\n\u003cli\u003eGuntupalli SR, Ramirez PT, Anderson ML, Milam MR, Bodurka DC, Malpica A (2009) Uterine smooth muscle tumor of uncertain malignant potential: a retrospective analysis. 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PAMJ-Clinical Medicine \u003cem\u003e3\u003c/em\u003e(82)\u003c/li\u003e\n\u003cli\u003eIp PP, Cheung AN, Clement PB (2009) Uterine smooth muscle tumors of uncertain malignant potential (STUMP): a clinicopathologic analysis of 16 cases. Am J Surg Pathol 33(7):992-1005\u003c/li\u003e\n\u003cli\u003eHuang G, Gao H, Chen Y, et al (2023) Platelet-to-Lymphocyte Ratio (PLR) as the Prognostic Factor for Recurrence/Residual Disease in HSIL Patients After LEEP. J Inflamm Res 16:1923-1936\u003c/li\u003e\n\u003cli\u003eCetin Arslan H, Yılmaz N, Arslan K (2025) Prognostic Value of Systemic Immune-inflammation Index in Early- and Late-Onset Preeclampsia. Comprehensive Medicine 17(2): 124-129\u003c/li\u003e\n\u003cli\u003eArslan K, Sahin AS (2025) Prognostic Value of Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index on Functional Status and Mortality in Patients with Critical Acute Ischemic Stroke. Tohoku J Exp Med 265(2):91-97\u003c/li\u003e\n\u003cli\u003eArslan K, Sahin AS (2024) Prognostic value of systemic immune-inflammation index, neutrophil-lymphocyte ratio, and thrombocyte-lymphocyte ratio in critically ill patients with moderate to severe traumatic brain injury. Medicine (Baltimore) 103(29):e39007.\u003c/li\u003e\n\u003cli\u003eHuo L, Wang D, Wang W, et al (2020) Oncologic and Reproductive Outcomes of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Single Center Retrospective Study of 67 Cases. Front Oncol 10:647\u003c/li\u003e\n\u003cli\u003eBosoteanu M, Deacu M, Voda RI, et al (2022) Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma. Clin Pract 12(6):897-907\u003c/li\u003e\n\u003cli\u003eBacanakgil BH, Deveci M, Karabuk E, Soyman Z (2017) Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Clinicopathologic-Sonographic Characteristics, Follow-Up and Recurrence. World J Oncol 8(3):76-80\u003c/li\u003e\n\u003cli\u003eJenabi E, Khazaei S, Aghababaei S, Soltani F (2022) The Association Between Overweight or Obesity and the Risk of UterineLeiomyoma: A Meta-Analysis. Current Women`s Health Reviews 18 (4):e031121195562\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;rb\u0026uuml;z, T, Yardımcı O, Udum S, G\u0026uuml;nay T (2020) The relationship between body mass index and clinical complications among patients undergoing myomectomy. Journal of Surgery and Medicine 4(11):1027-1030\u003c/li\u003e\n\u003cli\u003eBorella F, Cosma S, Ferraioli D, et al (2022) Clinical and Histopathological Predictors of Recurrence in Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Multicenter Retrospective Cohort Study of Tertiary Centers. Ann Surg Oncol 29(13):8302-8314\u003c/li\u003e\n\u003cli\u003eHelvacioglu C, Eroğlu M, Yal\u0026ccedil;ınkaya C, et al (2024) Smooth muscle tumor of uncertain malignant potential (STUMP): a case-based analysis. Ginekol Pol 95(8):590-595\u003c/li\u003e\n\u003cli\u003eWise LA, Palmer JR, Harlow BL, et al (2004) Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol 159(2):113-123\u003c/li\u003e\n\u003cli\u003eWise LA, Laughlin-Tommaso SK (2016) Epidemiology of Uterine Fibroids: From Menarche to Menopause. Clin Obstet Gynecol 59(1):2-24\u003c/li\u003e\n\u003cli\u003eZhang C, Gao J, Lu S, Zhang Y, Zhu H (2021) Uterine smooth muscle tumors of uncertain malignant potential (STUMP): A retrospective study in a single center. Eur J Obstet Gynecol Reprod Biol 265:74-79\u003c/li\u003e\n\u003cli\u003eNishigaya Y, Kobayashi Y, Matsuzawa Y, et al (2019) Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma. J Obstet Gynaecol Res 45(1):189-194\u003c/li\u003e\n\u003cli\u003eSuh DS, Song YJ, Roh HJ, et al (2021) Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma. Cancer Manag Res 13:5001-5011\u003c/li\u003e\n\u003cli\u003eAkbarzadeh-Jahromi M, Todarbary N, Aslani FS, Najib F, Zare M, Amirmoezi F (2024) Uterine smooth muscle tumors of uncertain malignant potential: a retrospective evaluation of clinical pathology and immunohistochemistry features. Surg Exp Pathol 7(2)\u003c/li\u003e\n\u003cli\u003eDi Giuseppe J, Grelloni C, Giuliani L, Delli Carpini G, Giannella L, Ciavattini A (2022) Recurrence of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Systematic Review of the Literature. Cancers (Basel) 14(9):2323\u003c/li\u003e\n\u003cli\u003eCotrino I, Carosso A, Macchi C, et al (2020) Ultrasound and clinical characteristics of uterine smooth muscle tumors of uncertain malignant potential (STUMPs). Eur J Obstet Gynecol Reprod Biol 251:167-172.\u003c/li\u003e\n\u003cli\u003eLapresa-Alcalde MV, Ruiz-Navarro MJ, Sancho de Salas M, Cubo AM (2023) A Review and Follow-Up of Uterine Smooth Muscle Tumours of Uncertain Malignant Potential (STUMP): A Case Series and Literature Review. Diseases 11(3):99\u003c/li\u003e\n\u003cli\u003eBasaran D, Usubutun A, Salman MC, et al (2018) The Clinicopathological Study of 21 Cases With Uterine Smooth Muscle Tumors of Uncertain Malignant Potential: Centralized Review Can Purify the Diagnosis. Int J Gynecol Cancer 28(2):233-240\u003c/li\u003e\n\u003cli\u003eHuang GS, Chiu LG, Gebb JS, et al (2007) Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma. Gynecol Oncol 107(3):513-517\u003c/li\u003e\n\u003cli\u003eKim HS, Han KH, Chung HH, et al (2010) Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison. Eur J Surg Oncol 36(7):691-698\u003c/li\u003e\n\u003cli\u003ePrabawa IPY, Bhargah A, Liwang F, et al (2019) Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev 20(3):863-868\u003c/li\u003e\n\u003cli\u003eQin L (2024) The predictive value of NLR, PLR and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. Discov Oncol 15(1):91\u003c/li\u003e\n\u003cli\u003eMuangto T, Maireang K, Poomtavorn Y, et al (2022) Study on Preoperative Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratio (PLR) as a Predictive Factor in Endometrial Cancer. Asian Pac J Cancer Prev 23(10):3317-3322\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Smooth muscle tumor of uncertain malignant potential (STUMP), leiomyoma, lactate dehydrogenase (LDH), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI)","lastPublishedDoi":"10.21203/rs.3.rs-7577395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7577395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eUterine smooth muscle tumors of uncertain malignant potential (STUMP) are a rare tumor group that falls between benign and malignant uterine smooth muscle tumors. Our study aimed to compare the preoperative characteristics of patients diagnosed with STUMP and leiomyoma and to determine parameters that can be used in differential diagnosis.\u003c/p\u003e\u003ch2\u003eMaterial and Method:\u003c/h2\u003e\u003cp\u003eThis retrospective, cross-sectional study included 73 patients who underwent surgery between 2015 and 2023 with a preliminary diagnosis of uterine myoma and whose final pathology results were either STUMP (n\u0026thinsp;=\u0026thinsp;32) or leiomyoma (n\u0026thinsp;=\u0026thinsp;41). Demographic data, tumor characteristics, surgical procedures, biochemical (CA-125, LDH), and hematological parameters (hemogram, NLR, MLR, PLR, SII, SIRI) were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSTUMP patients were more frequently seen at an older age (p\u0026thinsp;=\u0026thinsp;0.040) and in the postmenopausal period (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to the leiomyoma group. Serum LDH levels were significantly higher in the STUMP group (p\u0026thinsp;=\u0026thinsp;0.017). Lymphocyte count was higher in the STUMP group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), and PLR was higher in the leiomyoma group (p\u0026thinsp;=\u0026thinsp;0.003). There were no significant differences in NLR, MLR, SIRI, and SII.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSerum LDH levels, lymphocyte counts, and PLR values ​​may be potential biomarkers for distinguishing STUMP from leiomyoma. These simple and accessible tests may contribute to preoperative clinical decision-making.\u003c/p\u003e","manuscriptTitle":"Preoperative Clinical and Hematological Parameters in the Differential Diagnosis of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) and Leiomyoma: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:01:33","doi":"10.21203/rs.3.rs-7577395/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-08T12:20:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T19:28:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T10:25:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326853516578722856680156708873981103434","date":"2025-09-21T20:24:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38253672776392351396810175261334777579","date":"2025-09-21T15:37:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32021202408937464788343106231971163467","date":"2025-09-21T15:36:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159275608681537324932995932243598854166","date":"2025-09-20T13:07:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-19T13:32:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-11T10:15:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T10:14:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2025-09-09T23:24:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8ed230d4-9834-4422-9bd6-19751ebe1ddd","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T07:26:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 01:01:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7577395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7577395","identity":"rs-7577395","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}