Preoperative indices of systemic inflammatory response as predictors of the presence of regional metastases in cervical cancer. (A systematic review and meta-analysis)

Accurate assessment of the status of regional lymph nodes in cervical cancer is difficult due to the limitations of imaging methods of clinical staging. Indices of the response may reflect the extent of the tumor. Objective. To determine the most significant systemic inflammatory indices for the preoperative assessment of the regional lymph nodes status in patients with cervical cancer, to evaluate their predictive significance. Material and methods. The study included eighteen retrospective cohort studies involving 5.000 patients with cervical cancer, which assessed the relationship between systemic inflammatory indices and the lymph node status confirmed by the results of surgical staging. The data was searched in PubMed eLibrary, Google Scholar, Web of Science and Research Gate until March 2024. The meta-analysis was performed using random effects models to calculate the odds ratio (OR) with 95% confidence intervals. Results. The meta-analysis showed that systemic inflammatory indices can be used to improve the preoperative diagnosis of the risk of regional metastasis in patients with cervical cancer. The most significant indices are the ratio of neutrophils to lymphocytes and platelets to lymphocytes (NLR and PLR). High values of NLR (>2.78) and PLR (>149.3) are associated with the presence of regional metastases (NLR: OR=1.81 [1.50—2.19], I2=6%; PLR: OR=1.80 [1.46—2.21], I2=0%, p<0.001). At thresholds above these values, minimal heterogeneity and a more pronounced effect were observed. Conclusion. NLR and PLR are promising preoperative markers for assessing the risk of regional metastasis in cervical cancer. They can be used as an adjunct to standard clinical staging of cervical cancer.