ArticleJournal of ovarian research2026
Systemic immune and coagulation amplifiers resolve diagnostic ambiguity in endometriosis-associated ovarian cancer.
Article in Journal of ovarian research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPreoperative discrimination between endometriosis-associated ovarian cancer (EAOC) and benign ovarian endometrioma (OE) remains challenging because imaging findings overlap and CA125 is frequently elevated by benign pelvic inflammation. We hypothesized that EAOC is associated with a systemic immune-coagulation signature that could improve risk stratification beyond tumor markers alone.
methodsWe retrospectively analyzed treatment-naive patients who underwent primary surgery for ovarian masses between January 2015 and February 2025. EAOC (n = 49) and OE (n = 146) were confirmed histopathologically according to the Sampson-Scott criteria. Preoperative laboratory indices obtained within 2 weeks before surgery included fibrinogen, albumin, absolute monocyte count (AMC), CA125, and HE4; the fibrinogen-to-albumin ratio (FAR) was calculated. A multivariable logistic regression model integrating age, menopausal status, AMC, FAR, CA125, and HE4 was developed as the CO-MHF nomogram. Supplementary data-driven analyses included least absolute shrinkage and selection operator (LASSO) logistic regression, Akaike information criterion (AIC)-based stepwise selection, and add-one/drop-one marginal contribution analysis. Discrimination, calibration, and clinical utility were assessed by area under the receiver operating characteristic curve (AUC), bootstrap-derived confidence interval (CI), the Hosmer-Lemeshow test, and decision curve analysis (DCA).
resultsFAR and AMC were significantly higher in EAOC than in OE (median FAR 0.10 versus 0.07; median AMC 0.39 versus 0.31 × 10
conclusionsA mechanism-informed nomogram combining FAR and AMC with established tumor markers may improve preoperative risk stratification for EAOC. This host-response framework merits further evaluation in other malignancy-versus-inflammation diagnostic settings, although prospective multicenter validation and clinical threshold optimization remain necessary.
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