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

Yue Hu; Zhiyi Wang; Lishuo Dong; Lu Zhang; Li Xiuyang

doi:10.3389/fonc.2024.1333094

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

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

Authors

Yue Hu¹, Zhiyi Wang¹, Lishuo Dong², Lu Zhang³, Li Xiuyang⁴

Affiliations

¹ Qi-Huang Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
² College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.
³ Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
⁴ Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

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.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine [grant numbers ZYYCXTD-D-202001], Scientific and Technological innovation project of China Academy of Chinese Medical Sciences [grant numbers CI2021A01602], and Special Project for the Construction of Clinical Medical Research Centre of Guang’anmen Hospital, China Academy of Traditional Chinese Medicine[grant numbers 2022LYJSZX08].