Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis

Arikin Abdeyrim, Shizhi He, Yang Zhang, Gulbostan Mamtali, Aibadla Asla, Mirkamil Yusup, Jiang Liu, Arikin Abdeyrim, Shizhi He, Yang Zhang, Gulbostan Mamtali, Aibadla Asla, Mirkamil Yusup, Jiang Liu

Abstract

Background: 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 meta-analysis.

Methods: Pubmed, 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.

Results: A 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.

Conclusion: LNR 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.

Keywords: Hypopharyngeal cancer; Laryngeal cancer; Lymph node ratio; Meta-analysis; Prognosis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA literature screening flow diagram. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) literature screening flow diagram
Fig. 2
Fig. 2
Forest plot of the meta-analysis regarding the overall survival (OS). Forest plot of the meta-analysis using the random-effect model in patients with LHSCC regarding OS. OS: Overall survival; HR: Hazard ratio; LHSCC: Laryngeal and hypopharyngeal squamous cell carcinoma
Fig. 3
Fig. 3
Forest plot of the meta-analysis regarding the disease-specific survival (DSS). Forest plot of the meta-analysis using the random-effect model in patients with LHSCC regarding DSS. DSS: Disease-specific survival; HR: Hazard ratio; LHSCC: Laryngeal and hypopharyngeal squamous cell carcinoma
Fig. 4
Fig. 4
Forest plot of the meta-analysis regarding the disease-free survival (DFS). Forest plot of the meta-analysis using the fixed-effect model in patients with LHSCC regarding DFS. DFS: Disease-free survival; HR: Hazard ratio; LHSCC: Laryngeal and hypopharyngeal squamous cell carcinoma

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