Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 02 07 1 11 Wenhua Wang The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China AND Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Gansu, China Yanbin Jin Department of Obstetrics and Gynecology, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, China AND Key Laboratory of Reproductive Health Diseases Research and Translation, Hainan Medical University, Ministry of Education, Haikou, China Yongxiu Yang The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China AND Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Gansu, China 2025 03 31 2025 10 17 Immune and inflammatory factors influence endometrial cancer outcomes, the pan-immune inflammation value (PIV) shows potential but remains underexplored. This study aims to evaluate the relationship between preoperative PIV, T cell subtypes, and surgical prognosis in endometrial cancer patients, providing insights for prognostic markers and predictive models. We conducted a prospective observational study involving 101 endometrial cancer patients from August 2022 to August 2024. Based on prognosis within 6 months post-surgery, patients were divided into good and poor prognosis groups. We compared clinical characteristics, inflammatory indices, and T cell immune profiles between the groups. The mean age of participants was 50.12 years, with 23 patients experiencing a poor prognosis. The poor prognosis group exhibited significantly higher proportions of advanced International Federation of Gynecology and Obstetrics (FIGO) stage, larger tumor diameter, elevated neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and PIV. Conversely, this group showed lower proportions receiving neoadjuvant chemotherapy, CD4+ T cells, and CD4+CD8+ T cell ratios. Notably, elevated PIV emerged as an independent risk factor for poor prognosis, while increased CD4+ T cell proportion and CD4+CD8+ ratio were protective. PIV is significantly associated with poor prognosis in endometrial cancer, serving as an independent risk factor. Higher CD4+ T cell counts and CD4+:CD8+ ratios provide protective benefits. The constructed logistic regression model demonstrates strong predictive capability for post-surgical outcomes. However, limitations, including sample size and short follow-up, necessitate further investigation in larger cohorts. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4402 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4402/2297