Evaluating the diagnostic value of PLR and related hematologic parameters combined with CA-125 for endometriomas

Pingping Su, Yanni Huang, Huang Y, Kang F, Fenhong Kang, Zhang L, Lili Zhang, Lirui Yu, Yu L, Liu H, Hongli Liu
International Journal of Gynecology & Obstetrics · 2026 · doi:10.1002/ijgo.71444 · PMID:42897934 · W7223034925
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This retrospective study of 645 patients found that elevated CA-125 levels offer superior diagnostic value for ovarian endometriomas compared to platelet-to-lymphocyte ratio combinations and correlate with disease stage and inflammatory activity.

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Abstract

OBJECTIVE: Endometriosis is a chronic inflammatory disease, with inflammation relating to pathogenesis and staging. We compared inflammatory indices and clinical characteristics between patients with ovarian endometriomas and those with benign ovarian tumors to evaluate their diagnostic value and identify affordable blood markers for diagnosis and staging. METHODS: This retrospective single-center case-control study included 645 patients having laparoscopic surgery between January 1, 2020 and December 31, 2024: 372 with endometriosis and 273 controls with benign ovarian teratomas. Blood parameters and clinical characteristics were compared with Mann-Whitney U and t-tests. Independent risk factors for endometrioma and staging were evaluated using binary logistic regression. Predictive efficacy was assessed via receiver operating characteristic curves. Relationships between cancer antigen 125 (CA-125) and hematologic parameters were determined with correlation analyses. RESULTS: Compared with controls, patients with endometrioma had higher platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR) × CA-125, and monocyte-to-lymphocyte ratios (MLR) × CA-125, PLR × CA-125, and CA-125. Patients with endometrioma had more pelvic pain, larger cysts, and fewer pregnancies than controls. Higher CA-125 and visual analog scale (VAS) scores occurred with endometriomas. Patients with stage IV had higher platelet counts, NLR × CA-125, MLR × CA-125, PLR × CA-125, and CA-125 levels than Stage III. Preoperative bilateral endometriomas and elevated CA-125 were independent risk factors for Stage IV. CA-125 was positively correlated with PLR, cyst diameter, cyst area, VAS score, and bilateral endometriomas. CONCLUSION: The staging system is important for assessing endometrial lesions, although it may not reflect the level of inflammatory activity. For patients with dysmenorrhea or pelvic pain, elevated CA-125 demonstrated superior diagnostic value for ovarian endometrioma compared with PLR × CA-125, and could serve as a simple, cost-effective, and efficient assessment tools, providing information regarding endometriosis to inform clinical decision-making.

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