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. 2024 Feb 7:14:1333094.
doi: 10.3389/fonc.2024.1333094. eCollection 2024.

The prognostic value of lymph node ratio for thyroid cancer: a meta-analysis

Yue Hu  1 , Zhiyi Wang  1 , Lishuo Dong  2 , Lu Zhang  3 , Li Xiuyang  4
Affiliations

The prognostic value of lymph node ratio for thyroid cancer: a meta-analysis

Yue Hu et al. Front Oncol. .

Abstract

Background: The prognostic value of lymph node ratio (LNR) has been proved in several cancers. However, the potential of LNR to be a prognostic factor for thyroid cancer has not been validated so far. This article evaluated the prognostic value of LNR for thyroid cancer through a meta-analysis.

Methods: A systematic search was conducted for eligible publications that study the prognostic values of LNR for thyroid cancer in the databases of PubMed, EMBASE, Cochrane, and Web of Science up until October 24, 2023. The quality of the eligible studies was evaluated by The Newcastle-Ottawa Assessment Scale of Cohort Study. The effect measure for meta-analysis was Hazard Ratio (HR). Random effect model was used to calculate the pooled HR and 95% confidence intervals. A sensitivity analysis was applied to assess the stability of the results. Subgroup analysis and a meta-regression were performed to explore the source of heterogeneity. And a funnel plot, Begg's and Egger's tests were used to evaluate publication bias.

Results: A total of 15,698 patients with thyroid cancer from 24 eligible studies whose quality were relatively high were included. The pooled HR was 4.74 (95% CI:3.67-6.11; P<0.05) and a moderate heterogeneity was shown (I2 = 40.8%). The results of meta-analysis were stable according to the sensitivity analysis. Similar outcome were shown in subgroup analysis that higher LNR was associated with poorer disease-free survival (DFS). Results from meta-regression indicated that a combination of 5 factors including country, treatment, type of thyroid cancer, year and whether studies control factors in design or analysis were the origin of heterogeneity.

Conclusion: Higher LNR was correlated to poorer disease free survival in thyroid cancer. LNR could be a potential prognostic indicator for thyroid cancer. More effort should be made to assess the potential of LNR to be included in the risk stratification systems for thyroid cancer.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=477135, identifier CRD42023477135.

Keywords: disease-free survival; lymph node ratio; meta-analysis; prognosis; thyroid cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of included studies.
Figure 2
Figure 2
Forest plots and pooled estimates of the effect for meta-analysis of the association between LNR and disease-free survival in patients with thyroid cancer.
Figure 3
Figure 3
Sensitivity analysis of the association between LNR and disease-free survival in patients with thyroid cancer.
Figure 4
Figure 4
Forest plot for subgroup analysis by histological type of thyroid cancer.
Figure 5
Figure 5
Forest plot for subgroup analysis by treatment for thyroid cancer.
Figure 6
Figure 6
Forest plot for subgroup analysis by location of studies.
Figure 7
Figure 7
Forest plot for subgroup analysis by ranges of LNR cut-off values.
Figure 8
Figure 8
Forest plot for subgroup analysis by whether studies control factors in design or analysis to ensure the comparability of cohorts.
Figure 9
Figure 9
Forest plot for subgroup analysis by whether cases with extra thyroid extension were excluded.
Figure 10
Figure 10
Funnel plot of included studies.
Figure 11
Figure 11
Begg’s funnel plot with pseudo 95%confidence limits.
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