Prognostic Significance Of Pretreatment Neutrophil-to-Lymphocyte Ratio(NLR),Platelet-to-Lymphocyte Ratio(PLR) And Monocyte-to-Lymphocyte Ratio(MLR) In Endometrial Neoplasms:A Meta-Analysis

Aim: Neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),and monocyte-lymphocyte ratio(MLR)have been shown to be related to the poor prognosis of cervical cancer,ovarian cancer,breast cancer and other malignant tumors,but their role in predicting the prognosis of endometrial cancer is still controversial.Therefore,we conducted this meta-analysis to more accurately evaluate the effectiveness of NLR,PLR or MLR in predicting the prognosis of endometrial cancer(EC).Methods: This review systematically searched for relevant publications in databases of the Cochrane Library,Pub Med,EMBASE,CNKI,Wan Fang,VIP,and CBM.Pooled hazard ratios(HRs)with 95% confidence intervals(95% CIs)were determined and used to explore the association between inflammatory biomarkers(NLR,PLR,MLR)and overall survival(OS),progression-free survival(PFS)and disease-free survival(DFS)in a random-effects model.We also conducted subgroup analysis,sensitivity analysis,publication bias in this meta-analysis.Stata 12.0 was used for statistical analysis.Results: This meta-analysis contained 14 eligible studies including 5274 patients.Our results showed that NLR and PLR was associated with OS(NLR: hazard ratio [HR]: 2.51,95% confidence interval [CI] 1.70-3.71 in Ua,p=0;HR: 1.87,95%CI 1.34-2.60 in Ma,p=0;PLR: HR: 2.50,95%CI 1.82-3.43 in Ua,p=0;HR: 1.86,95%CI 1.22-2.83 in Ma,p=0.004),but MLR was not associated with OS(HR: 1.44,95%CI 0.70-2.95 in Ua,p=0.325;HR: 1.01,95%CI 0.39-2.60 in Ma,p=0.987).Further subgroup analysis found that the correlations were not affected by race or cut-off value or sample size(<300 or ≥300)or treatment(surgery,surgery + chemistry,surgery + radiation,surgery + chemistry + radiation).Our meta-analysis showed that NLR,PLR was associated with DFS(NLR: HR: 2.50,95% CI 1.38-4.56,P=0.003 in Ua;HR: 2.06,95%CI 1.26-3.37,P=0.004 in Ma.PLR: HR: 1.91,95% CI1.30-2.81,p=0.001 in Ua).Only in univariate analysis(Ua)there exists connection between NLR and PFS(Ua: HR: 1.71,95% CI 1.04-2.81,P=0.035;Ma: HR: 1.79,95%CI 0.65-4.89,P=0.257).However,MLR was also not associated with DFS(HR: 0.36,95% CI 0.03-4.13p=0.409 in Ua).Conclusions: Our results indicated that pretreatment NLR and PLR were biomarkers of poor prognosis in patients with endometrial cancer.The results indicated that NLR or PLR was associated with overall survival(OS),and NLR or PLR was associated with DFS.Furthermore,NLR was associated with PFS only in univariate analysis(Ua);But MLR was not associated with DFS or OS.