Preoperative Serum C-Reactive Protein Levels Are Elevated in Uterine Sarcoma Compared with Leiomyoma: A Retrospective Cohort Study

Background: Uterine sarcomas are rare but highly aggressive mesenchymal malignancies associated with poor survival. Preoperative differentiation from benign leiomyomas remains a critical oncologic challenge, frequently resulting in unexpected postoperative diagnoses and potential tumour dissemination during morcellation. Reliable, accessible biomarkers to support preoperative risk assessment are lacking. This study evaluated whether CRP, a systemic inflammatory marker implicated in tumour biology, could aid in the preoperative identification of uterine sarcoma. Methods: This retrospective single-centre study included 39 patients with histologically confirmed uterine sarcoma and 39 patients with leiomyoma treated between 2010 and 2021. Preoperative serum CRP levels were compared between groups. As data were non-normally distributed, the Mann–Whitney U test was used for comparisons, and Spearman’s rank correlation was applied for association analyses. Results: Patients with sarcoma were significantly older than controls (56.2 ± 12.9 vs. 39.2 ± 6.7 years, p 5 mg/L) was observed in 53.8% of sarcoma cases versus 2.6% of controls. Undifferentiated sarcomas demonstrated the highest CRP levels. CRP levels were not significantly associated with tumour aggressiveness. A moderate negative correlation between age and preoperative CRP was identified (r = −0.476, p = 0.029). Receiver operating characteristic analysis demonstrated a moderate discriminatory ability of preoperative CRP for differentiating uterine sarcoma from leiomyoma (AUC 0.751, 95% CI 0.668–0.834). Conclusions: Elevated preoperative CRP levels are significantly associated with uterine sarcoma and may enhance oncologic risk stratification prior to surgery. Integration of CRP into multimodal preoperative assessment algorithms could improve surgical planning and reduce the risk of inadvertent tumour dissemination. Prospective multicentre studies are required to validate its diagnostic performance and define clinically relevant cut-off values.