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SYSTEMATIC REVIEW article

Front. Oncol.
Sec. Gynecological Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1475348

The Prognostic Values of Lymph Node Ratio for Gynecological Cancer: a systematic review and meta-analysis

Provisionally accepted
Mengmeng Chen Mengmeng Chen Yisi Wang Yisi Wang Yali Chen Yali Chen Ling Han Ling Han *Zheng Ai Zheng Ai *
  • Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China

The final, formatted version of the article will be published soon.

    Background: To determine the relationship between the lymph node ratio (LNR) and the prognostic values of gynecological cancer.Materials and methods: PubMed, Web of Science, Embase and Central Cochrane Library were used to search for studies on LNR and gynecological cancer published before April 18, 2024.The effect measure for meta-analysis of primary outcomes was the hazard ratio (HR) for overall survival (OS), progression-free survival (PFS), disease-free survival (DFS). Pooled HRs and 95% confidence intervals (CI) were calculated using random or fixed effects models. Sensitivity analysis was applied to evaluate the robustness of the results. The I 2 statistic was used to measure heterogeneity. Subgroup analysis and meta-regression were chosen to illustrate the potential heterogeneity of the risk factors of outcomes. Publication bias was assessed using Egger's test and Begg's funnel plots.Results: A total of 34 studies with 23202 cases were included in this meta-analysis. Metaanalysis found higher LNR was associated with worse OS (HR=2.42, 95%CI:2.07-2.83; I 2 =77.4%, p<0.05), PFS (HR=1.97, 95%CI:1.66-2.32; I 2 =0.00%, p>0.05), and DFS (HR=3.18, 95%CI:2.12-4.76; I 2 =64.3%, p<0.05). Besides, Meta-analysis revealed significant differences in the association between LNR and OS of cervical cancer(CC) (HR=2.53, 95%CI:1.94-3.31; I 2 =72.6%, p<0.05), ovarian cancer(OC) (HR=2.05, 95%CI:1.66-2.54; I 2 =76.7%, p<0.05), endometrial cancer(EC) (HR=2.16, 95%CI:1.48-3.16; I 2 =53.6%, p<0.05), and vulvar cancer(VC) (HR=8.13, 95%CI:3.41-19.43; I 2 =57.2%, p<0.05).We observed a clear association between higher LNR and poorer prognosis in our study of patients with gynecological cancer. Further prospective study is warranted to determine optimal LNR and if LNR may inform adjuvant therapy use in gynecological cancer.It is essential to conduct further prospective studies to establish the optimal LNR threshold, determine minimum threshold of lymph node removal, and investigate whether LNR can serve as a reliable marker for guiding adjuvant therapy choices in gynecological cancer.

    Keywords: lymph node ratio, gynecological cancer, prognosis, Systematic review, metaanalysis

    Received: 03 Aug 2024; Accepted: 09 Sep 2024.

    Copyright: © 2024 Chen, Wang, Chen, Han and Ai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ling Han, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
    Zheng Ai, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China

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