Supervisors info:
Σεργεντάνης Θεόδωρος, Επίκουρος Καθηγητής, Τμήμα Πολιτικών Δημόσιας Υγείας, ΠΑΔΑ
Ψαλτοπούλου Θεοδώρα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Τέρπος Ευάγγελος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
The value of lymph node ratio as a prognostic factor affecting survival, in mixed cohorts of node-positive and node-negative patients with oral squamous cell carcinoma: A systematic review and meta-analysis.
Translated title:
The value of lymph node ratio as a prognostic factor affecting survival, in mixed cohorts of node-positive and node-negative patients with oral squamous cell carcinoma: A systematic review and meta-analysis.
Summary:
Oral cavity cancer was the 16th most common type of cancer globally in year 2020, with an incidence rate of 377,713 new cases. Oral squamous cell carcinoma (OSCC) is the most usual type, with main predisposing factors tobacco exposure and alcohol consumption and nodal metastasis associated with poor prognosis. Lymph node ratio (LNR), representing the ratio of positive lymph nodes extracted during a neck dissection to the total nodal yield, is a well established prognostic factor for colorectal and breast cancer. During the last years, research has also proven the clinical implication of LNR in OSCC prognosis, aiming at a more precise disease classification. The main purpose of this study is to prove that LNR, as a dichotomous categorical variable, is an independent prognostic factor for OSCC. A systematic search was conducted in the following databases to result in 32 studies published between 2009 and 2020; PubMed, EMBASE, Cochrane library and ClinicalTrials.gov. Pooled relative risk/hazard ratio was calculated, along with 95% confidence intervals for the following endpoints; overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), distant metastasis-free survival (DMFS) and locoregional disease-free survival (LRDFS), according to random-effects models, including subgroup and meta-regression analyses. 20 cohort studies, including node-negative patients, were eligible for meta-analysis. Patients with high LNR versus those with low LNR, had shorter OS (RR: 2.38, 95% CI: 1.99- 2.85), DFS (RR: 2.04, 95% CI: 1.48- 2.81) and DSS (RR: 2.90, 95%CI: 2.35- 3.57). LNR seems to be a significant, independent prognostic factor concerning OSCC patients, very likely to be incorporated in future classification systems for better risk stratification.
Keywords:
Oral squamous cell carcinoma, Lymph node ratio, Lymph node yield, Neck dissection, Survival
