Abstract
BACKGROUND: Evaluating the risk of metastasis at diagnosis and the likelihood of future recurrence is crucial for the effective management of endometrial cancer (EC). While conventional prognostic indicators hold importance, they often fall short in predicting recurrence, especially in low-risk patients. This study evaluates the prognostic value of the lymphocyte-to-monocyte ratio (LMR) for overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) in EC patients. METHODS: Eligible studies that provided pretreatment cutoff values of LMR, hazard ratios (HRs), and 95% confidence intervals (CIs) for OS, DFS, CSS, and progression-free survival (PFS) were included in this meta-analysis. Two independent reviewers collected and evaluated the data, and the quality of the included studies was assessed using the Newcastle Ottawa Quality Assessment Scale (NOS). Statistical analyses were performed using STATA software, and subgroup analyses were conducted by race, sample size, and age to assess the consistency of LMR's prognostic value across different population groups. RESULTS: In this meta-analysis, eight studies were included for OS (1,997 patients) and five studies were included for DFS (1,590 patients). LMR was significantly associated with OS (HR 2.29; 95% CI [1.50-3.51]; p = 0.0014), DFS (HR 4.00; 95% CI [1.76-9.07]; p = 0.0094), and CSS (HR, 1.58; 95% CI [1.11-2.25]; p = 0.01). Subgroup analysis indicated that the prognostic value of LMR for OS was consistent across different races, age groups, and sample sizes. However, the correlation between LMR and DFS was influenced by median age, with younger patients (<60 years) showing a stronger association. Sensitivity analyses confirmed the robustness of these results, and Egger's test showed no significant publication bias. DISCUSSION: LMR serves as a valuable prognostic marker for OS, DFS, and CSS in EC patients. Its predictive power remains significant across diverse population groups, underscoring its potential utility in clinical practice. Biological mechanisms linking inflammation and cancer support the role of LMR in prognosis, given the functions of lymphocytes and monocytes in tumor progression and immune response. These findings suggest that incorporating LMR into current prognostic models could enhance risk stratification for EC patients, particularly for identifying those at higher risk of recurrence despite being classified as low risk by traditional systems. In conclusion, LMR is a robust, independent prognostic factor for EC, with significant implications for improving patient management and outcomes through better risk stratification.