Abstract
PurposeElevated inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been identified as poor predictors of survival in several malignancies. This meta-analysis was performed to quantify the effect of pretreatment NLR and PLR on the survival of patients with endometrial cancer (EC).MethodsThis review systematically searched for relevant publications in databases of PubMed, Embase, and the Cochrane Library. Pooled hazard ratios (pHRs) with 95% confidence intervals (95% CIs) were determined and used to explore the association between inflammatory markers and overall survival (OS) and disease-free survival (DFS) in a random-effects model. Subgroup analysis, sensitivity analysis, and publication bias were also conducted in this meta-analysis.ResultsNine articles comprising 3390 patients were included. NLR higher than the cutoff was associated with a shorter OS (pHR = 2.22, 95% CI 1.77–2.78) and poorer PFS (pHR = 1.81, 95% CI 1.35–2.41). Patients with elevated PLR had high risk of decreased OS (pHR = 1.99, 95% CI = 1.51–2.61) and unfavorable PFS (pHR = 2.02, 95% CI 1.45–2.80).ConclusionsElevated NLR and PLR during pretreatment are biomarkers of poor prognosis in patients with EC.
Highlights
Endometrial cancer (EC) is the most common malignancy of the female reproductive system in developed countries [1]
Studies have begun exploring prognostic values of inflammatory markers, including the neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as biomarkers of systemic inflammatory responses associated with cancer development and progression [5,6,7]
The results revealed that analysis method was likely to be a source of heterogeneity among studies on the association between PLR and overall survival (OS)
Summary
Endometrial cancer (EC) is the most common malignancy of the female reproductive system in developed countries [1]. For patients diagnosed with stage III or IV disease, 5-year survival rate decreased to 57–66% and 20–26%, Liwei Ni and Jialong Tao contributed to this work. Survival of patients with EC depends on prognostic factors, such as age at diagnosis, comorbidities, tumor diameter, positive lymph nodes, histological grade and subtype, tumor grade, lymphovascular space involvement (LVSI), and FIGO stage [4]. Studies have begun exploring prognostic values of inflammatory markers, including the neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as biomarkers of systemic inflammatory responses associated with cancer development and progression [5,6,7]. Jiang et al [11] demonstrated that a higher level of PLR was not significantly associated with overall survival (OS) in EC in a combined analysis of three studies. Ding et al [12] identified that PLR and NLR greater than the cutoff was associated with poorer
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