Abstract
BackgroundSeveral recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and meta-analysis.MethodsPubmed, Embase (via Ovid), and Cochrane library were systematically searched for studies on the prognostic value of LNR in LHSCC up to October 31, 2019. Then, Literature review, data extraction, and quality assessment of eligible studies were performed by two independent reviewers back-to-back. Lastly, Stata 14.0 software was hired to conduct a meta-analysis.ResultsA total of 445 articles were retrieved, and 13 studies published in English between 2013 and 2019 were included after the title/abstract and full-text screening. Among the 13 studies contributed to 4197 patients, seven studies were about hypopharyngeal squamous cell carcinoma (HPSCC), four studies about laryngeal squamous cell carcinoma (LSCC), and the remaining two studies about LHSCC. The meta-analysis results showed that shorter overall survival (OS) (HR 1.49; 95%CI: 1.18 to 1.88), disease-specific survival (DSS) (HR 1.66; 95%CI: 1.32 to 2.07) and disease-free survival (DFS) (HR 2.04; 95%CI: 1.54 to 2.71) were significantly correlated with a higher LNR in a random-effect model. The cutoff values of eligible studies were varied from 0.03 to 0.14, and the lowest significant LNR was 0.044.ConclusionLNR is a valuable prognostic factor in the survival of LHSCC and may be used to improve the tumor staging systems, which, however, requires the solid support of more high-quality studies.
Highlights
Treatment of laryngeal and hypopharyngeal cancer was frustrating due to its dysfunction and poor prognosis
Study selection We had access to all published articles which evaluated the prognostic values of lymph node ratio (LNR) in laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC), and included articles that were published in English, studied LHSCC patients with positive lymph nodes, reported calculated lymph node density (LND) or LNR, clarified the LNR-related outcomes, and applied multivariate regression analysis to analyze the relationship between LNR and outcomes
We retrieved 445 articles following the search strategy, among which 36 articles were eligible for the full-text screening process, and 13 articles [12–16, 18–22, 27–29] were included in the meta-analysis
Summary
Treatment of laryngeal and hypopharyngeal cancer was frustrating due to its dysfunction and poor prognosis. Some patients who have received surgery with adjuvant chemoradiotherapy after surgery, may still have a relapse. It is of importance to improve outcomes via seeking valuable prognostic factors and identifying patients at high risk of recurrence. Based on the tumor-node-metastasis (TNM) staging, the American Joint Committee on Cancer (AJCC) system [2] is the most commonly used staging system for laryngeal and hypopharyngeal cancers, which classified the status of lymph nodes of patients by their number, size, laterality, and extra nodal extension (ENE) [3]. Several recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and metaanalysis
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