Abstract
Background: Several recent studies have reported the reliable prognostic effect of hematological biomarkers in various tumors. Yet, the prognostic value of these hematological markers in soft tissue sarcoma (STS) remains inconclusive. Thus, the aim of this meta-analysis was to check the effect of hematological markers on the prognosis of STS.Methods: We systematically searched for relevant papers published before October 2019 in the PubMed and EMBASE databases. Overall survival (OS) and disease-specific survival (DSS) were the primary outcome, whereas disease-free survival was the secondary outcome. A thorough study of hazard ratios (HR) and 95% of confidence intervals (CIs) was done for determining the prognostic significance.Results: We performed 23 studies that comprised of 4,480 patients with STS. The results revealed that higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and platelet-to-lymphocyte ratio (PLR) were associated with poor OS/DFS (HR = 2.08/1.72, for NLR; HR = 1.92/1.75, for CRP, and HR = 1.86/1.61, for PLR). In contrast, a low lymphocyte-to-monocyte ratio (LMR) was relate to worse OS/DFS (HR = 2.01/1.90, for LMR). Moreover, pooled analysis illustrated that elevated NLR and CRP represents poor DSS, with HRs of 1.46 and 2.06, respectively. In addition, combined analysis revealed that higher Glasgow prognostic score (GPS) was linked to an adverse OS/DSS (HR = 2.35/2.77).Conclusion: Our meta-analysis suggested that hematological markers (NLR, CRP, PLR, LMR, and GPS) are one of the important prognostic indicators for patients affected by high-grade STS and patients with the STS being located in the extremity.
Highlights
RationaleSoft tissue sarcoma (STS) is a relatively rare, heterogeneous tumor derived primarily from the mesodermal layer
The inclusion criteria were as follows: [1] diagnosis of soft tissue sarcoma (STS) based on pathological examination; [2] the study assessed the prognostic value for a minimum of one hematologic marker through overall survival (OS), disease-specific survival (DSS), and/or disease-free survival (DFS); [3] hazard ratio (HR) was employed with a 95% confidence interval (CI) to represent the prognostic value of biomarkers; [4] studies published in English
The analysis showed that a higher Glasgow prognostic score (GPS) score is a useful prognostic marker for predicting DFS (HR: 2.77, 95% CI = 1.39–5.53, P = 0.004) with significant heterogeneity (I2 = 69%; Figure 7)
Summary
Soft tissue sarcoma (STS) is a relatively rare, heterogeneous tumor derived primarily from the mesodermal layer. Several prognostic factors including tumor size, depth, histologic tumor grade, and patient age have proven effective in guiding the design of treatment regimens for STS [3]. Mortality in Hematological Biomarkers in STS Prognosis patients with high-grade tumors is nearly 50%, primarily due to development of locally relapsed or metastatic tumors. More accurate predictive factors are required to allow for development of personalized treatment plans for high risk patients [4]. Several recent studies have reported the reliable prognostic effect of hematological biomarkers in various tumors. The prognostic value of these hematological markers in soft tissue sarcoma (STS) remains inconclusive.
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