Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Shengwei Kang; Junxiang Wu; Jie Li; Qing Hou; Bin Tang

doi:10.12659/MSM.934588

09 March 2022: Meta-Analysis

Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Shengwei Kang ^12BDE , Junxiang Wu ^2C , Jie Li ^2F , Qing Hou ^1DEF , Bin Tang ^2AG*

DOI: 10.12659/MSM.934588

Med Sci Monit 2022; 28:e934588

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Background Material and Methods Results Discussion Conclusions References

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Table 1 The baseline characteristics of included studies.

Study	Country	Study design	Sample size	Age (years)	FIGO stage	Follow-up (years)	Reported outcomes	Prognostic factors	NOS score
Sevin 1995 []²⁷	USA	Retro	301	43.5	I–II	5.0	DFS	DI, TS, LVSI, LNI, TV, FIGO, RM, CT, TG, age	6
Werner-Wasik 1995 []²⁸	USA	Retro	125	55.0	I–II	5.0	DFS	LNI, LVSI, PI, He, TS, FIGO, CT, TG	5
Tsai 1999 []²⁹	China	Retro	222	50.0	I–II	5.0	DFS	FIGO, TS, age, CT, SCC, He, LNI, PI, LVSI, RM	6
Lai 1999 []³⁰	China	Retro	891	NA	I–II	5.0	DFS	TG, FIGO, TS,DI	7
Nakanishi 2000 []³¹	Japan	Retro	509	49.3	I	9.3	OS, DFS	CT, LNI, and TS	6
Hernandez 2000 []³²	USA	Retro	291	49.7	II–IV	5.0	PFS	Th, LNI, TS, age, and FIGO	7
Alfsen 2001 []³³	Norway	Retro	505	53.0	I–IV	5.0	OS	CT, LVSI, LNI, and age	7
Flores-Luna 2001 []³⁴	Mexico	Retro	378	52.2	I–IV	12.5	OS	FIGO, TG, TS, and age	5
Trattner 2001 []³⁵	Austria	Retro	113	46.1	I–II	4.7	OS	TV, LNI, LVSI, FIGO, PI, RM, CT, TG, and age	5
Yanoh 2001 []³⁶	Japan	Retro	751	45.0	I	> 5.0	DFS	LNI, PI, TS, DI, and LVSI	6
Takeda 2002 []³⁷	Japan	Retro	187	48.2	I–II	6.9	OS	FIGO, CT, LVSI, TS, DI, PI, and LNI	6
Gasinska 2002 []³⁸	Poland	Retro	152	55.0	I–III	2.2	OS	Age, TG, and He	6
Martin-Loeches 2002 []³⁹	Spain	Retro	114	49.1	I–II	10.0	OS	TS, TV, DI	5
Brun 2003 []⁴⁰	France	Retro	308	53.0	I–IV	7.8	OS	Age, TG, and PI	6
Morice 2003 []⁴¹	France	Retro	193	37.0	I–II	5.0	OS	FIGO, TS, LVSI, and LNI	6
Kodaira 2003 []⁴²	Japan	Retro	164	68.0	II–III	1.9	DFS	TV, LNI, and FIGO	6
Grisaru 2003 []⁴³	Canada	Pro	871	42.1	I	4.1	DFS	LNI, TG, LVSI, RM, and CT	7
Huang 2003 []⁴⁴	China	Pro	157	44.0	I–II	5.0	OS, DFS	TS, age, CT	6
Shinohara 2004 []⁴⁵	Japan	Retro	130	49.0	I–II	14.4	DFS	LVSI, LNI, and DI	6
Ho 2004 []⁴⁶	China	Retro	197	47.4	I–II	5.8	OS, DFS	Age, FIGO, CT, TG, TS, DI, LVSI, LNI, PI	5
Ayhan 2004 []⁴⁷	Turkey	Retro	393	48.5	I	2.6	OS, DFS	TS, LVSI, PI,	6
Choi 2006 []⁴⁸	Korea	Retro	85	50.0	I–IV	3.0	OS, DFS	Age, CT, FIGO, TS, LNI, SCC, and He	5
Chittithaworn 2007 []⁴⁹	Thailand	Retro	205	44.2	I	4.7	DFS	DI, LVSI, RM, and LNI	5
Grigiene 2007 []⁵⁰	Lithuania	Retro	162	52.0	II–III	2.7	OS, DFS	FIGO, He	7
Horn 2007 []⁵¹	Germany	Retro	245	43.0	II	4.5	OS	TS, LNI, FIGO	6
Atahan 2007 []⁵²	Turkey	Retro	183	54.0	I–III	3.8	OS, DFS	Age, PI, FIGO, TS, CT, LNI	7
Garcia-Arias 2007 []⁵³	Mexico	Retro	294	49.4	I–IV	2.3	OS	Le, He, age, CT, and FIGO	7
Choi 2008 []⁵⁴	Korea	Retro	143	58.0	I–IV	2.2	PFS	FIGO, TS	6
Behtash 2009 []⁵⁵	Iran	Retro	203	49.8	I–II	3.5	OS, DFS	Age, CT, FIGO, TS, LNI, PI, LVSI, DI	6
Jacobson 2009 []⁵⁶	USA	Retro	436	52.3	I–IV	8.0	OS	FIGO, CT	7
Zusterzeel 2009 []⁵⁷	Netherlands	Retro	167	42.0	I–IV	2.8	OS, DFS	FIGO, CT, TG, LVSI, DI, TS	7
Polterauer 2010 []⁵⁸	Austria	Retro	88	49.9	I–IV	3.1	OS, DFS	FIGO, TG, CT	7
Munagala 2010 []⁵⁹	India	Retro	89	46.0	I–III	5.0–7.0	OS, DFS/PFS	Age, FIGO, LNI, PI, CT, TG, and TS	6
Huang 2010 []⁶⁰	China	Retro	960	45.0	I–II	5.0	OS	FIGO,SCC, DI, PI	6
Touboul 2010 []⁶¹	France	Retro	150	47.0	I–IV	3.6	OS	FIGO, CT, RM, LNI	7
Horn 2010 []⁶²	Germany	Retro	194	44.0	I–II	5.1	OS	LNI, TG, FIGO	6
Kodama 2010 []⁶³	Japan	Retro	97	46.0	I–II	8.4	OS, DFS	Age, FIGO, DI, TS, PI, LVSI, LNI	5
Lee 2010 []⁶⁴	Korea	Retro	134	58.0	II–IV	3.2	OS, PFS	FIGO	5
Tseng 2010 []⁶⁵	China	Pro	251	48.6	II–IV	6.3	OS	SCC, TS, PI, LNI	6
Nugent 2010 []⁶⁶	USA	Retro	111	51.0	I–IV	1.4	OS, PFS	FIGO	6
Srisomboon 2011 []⁶⁷	Thailand	Retro	680	44.5	I	4.0	DFS	LNI, LVSI, CT, DI, PI, TG, RM	6
Seamon 2011 []⁶⁸	USA	Retro	381	47.0	I–IV	3.3	OS, DFS	FIGO, CT, TG	7
Polterauer 2011 []⁶⁹	Austria	Retro	178	49.2	I–IV	3.8	OS, DFS	FIGO, LNI, TG, age, CT	7
Mabuchi 2011 []⁷⁰	Japan	Retro/Pro	536	57.5	I–IV	6.4	OS, PFS	Age, FIGO, CT, TS	6
Min 2011 []⁷¹	China	Retro	88	NA	I–II	5.0	OS	Age, TS, CT, TG, FIGO, LNI	5
Biewenga 2011 []⁷²	Netherlands	Retro	710	41.0	I–II	5.2	DFS	CT, TG, DI, PI, LNI, LVSI, RM	7
Polterauer 2012 []⁷³	Austria	Retro	528	47.9	I–IV	3.8	OS	Age, FIGO, TS, CT, LNI, PI	7
Kim 2012 []⁷⁴	Korea	Retro	174	NA	I–IV	2.5	OS, PFS	FIGO, LNI, TS	6
Lee 2012 []⁷⁵	Korea	Retro	1,061	50.0	I–IV	4.4	OS, PFS	NLR, FIGO, CT	7
Okazawa 2012 []⁷⁶	Japan	Retro	311	51.0	I–II	5.2	PFS	Age, CT, LNI, PI, RM, DI, LVSI, TS, He	7
Wang 2012 []⁷⁷	China	Retro	179	47.0	I–IV	4.3	OS, DFS	FIGO, LNI, RM	6
Yan 2012 []⁷⁸	China	Retro	148	42.0	I	2.3	OS	Age, CT, TG, TS, DI, LVSI, LNI	5
Cibula 2012 []⁷⁹	Czech Republic	Retro	645	46.0	I–II	3.3	OS, DFS	Age, FIGO, PI, LNI	6
Singh 2012 []⁸⁰	Australia	Retro	196	NA	I–II	6.1	OS, DFS	Age, LVSI, LNI, PI, TS, DI	7
Wang 2013 []⁸¹	China	Retro	424	NA	I–II	7.0	DFS	Age, CT, TG, FIGO, LNI	5
Tsubamoto 2013 []⁸²	Japan	Retro	73	47.0	I–II	5.9	OS, DFS	Age, FIGO, CT, TS, LNI	6
Song 2013 []⁸³	Korea	Retro	268	57.0	I–IV	5.0	OS, DFS	FIGO, age, LNI, CT, He	6
Cho 2013 []⁸⁴	Korea	Retro	185	50.0	I–II	5.9	DFS	Age, FIGO, LNI, RM, PI, TS, DI, LVSI	6
Zhang 2014 []⁸⁵	China	Retro	460	44.0	I–II	5.8	OS, PFS	FIGO, LNI, NLR	7
Horn 2014 []⁸⁶	Germany	Retro	366	40.0	I	7.8	OS, DFS	TS, LNI, TG	7
Noh 2014 []⁸⁷	Korea	Retro	1,323	50.0	I–II	6.3	OS, DFS	CT, age, FIGO, TS, LNI, PI, LVSI, DI, RM	7
Yu 2014 []⁸⁸	China	Retro	153	NA	II	5.0	DFS	TS, LVSI, LNI	6
Liu 2014 []⁸⁹	China	Retro	184	46.0	I–II	5.8	OS, DFS	Age, TS, CT, TG, FIGO, DI, LVSI, LNI	6
Kawano 2015 []⁹⁰	Japan	Retro	286	63.6	I–IV	6.7	OS	Age, FIGO, PNI, CT, TS, He, Th	7
Ruengkhachorn 2015 []⁹¹	Thailand	Retro	331	48.6	I–II	7.0	DFS	He, CT, FIGO, PNI, PI, RM, DI, LVSI	6
Bradbury 2015 []⁹²	UK	Retro	92	39.5	I	4.8	OS, PFS	Age, TS, CT, TG, LVSI, LNI, RM	7
Yuan 2015 []⁹³	China	Retro	38	40.4	I–II	5.0	OS, DFS	PI	6
Mizunuma 2015 []⁹⁴	Japan	Retro	56	65.1	I–IV	6.7	OS, PFS	FIGO, TS, He, NLR	6
Endo 2015 []⁹⁵	Japan	Retro	84	62.0	I–IV	6.7	OS	Age, CT, He, TS, LNI	6
Zhao 2015 []⁹⁶	China	Retro	220	NA	I–II	5.0	OS, DFS	Age, FIGO, TG, CT, DI, TS, LNI	7
Takatori 2015 []⁹⁷	Japan	Retro	33	42.0	I–II	2.8	OS	Age, FIGO, TS, SCC	5
Huang 2016 []⁹⁸	China	Retro	643	NA	I–II	3.1	OS, DFS	Age, CT, TG, TS, FIGO, DI, LVSI, LNI, PI, RM	7
Li 2016 []⁹⁹	China	Retro	347	51.6	I–II	3.1	OS, DFS	Age, CT, FIGO, TG, DI, LVSI, RM, LNI, PI, SCCA	7
Cho 2016 []¹⁰⁰	Korea	Retro	2,456	56.0	I–IV	5.4	OS, DFS	Age, FIGO, CT, TS, LNI, He, Le, NLR	7
Matsumiya 2016 []¹⁰¹	Japan	Retro	54	55.0	I–IV	1.0	OS	CT	6
Usami 2016 []¹⁰²	Japan	Retro	111	51.0	I–IV	1.4	OS	Age, CT	6
Chen 2016 []¹⁰³	China	Retro	407	44.0	I–II	5.0	OS, DFS	Age, CT, TG, DI, LVSI, LNI, FIGO, PI, PLR, NLR	6
Oishi 2016 []¹⁰⁴	Japan	Retro	85	55.0	IV	0.8	OS	Age, CT, TS, TG, He, SCC	5
Onal 2016 []¹⁰⁵	Turkey	Retro	235	57.0	I–IV	5.8	OS, PFS	Age, FIGO, TS, LNI, NLR	7
Wu 2016 []¹⁰⁶	USA	Retro	71	49.0	I–IV	2.1	OS, PFS	FIGO, CT, TG	6
Xia 2016 []¹⁰⁷	China	Retro	274	43.0	I–II	2.4	OS, DFS	Age, FIGO, CT, TS, TG, DI, LVSI, RM, PI, LNI	6
Lee 2017 []¹⁰⁸	Korea	Retro	231	58.0	I–IV	2.3	OS, PFS	Age, LNI, FIGO, SCC, TV	7
Barquet-Muñoz 2017 []¹⁰⁹	Mexico	Retro	202	49.5	I–II	5.0	OS, DFS	Age, CT, TS, DI, LVSI, RM, PI, LNI	6
Jung 2017 []¹¹⁰	Korea	Retro	1,113	48.7	I–II	7.6	OS, DFS	CT, FIGO, TS, DI, LNI, LVSI, PI, RM	7
Chung 2017 []¹¹¹	Korea	Retro	103	48.0	I–II	2.4	PFS	FIGO, TS, LNI, PI, DI, LVSI	5
Zheng 2017 []¹¹²	China	Retro	795	49.5	I–II	5.2	OS	FIGO, He, TG, LVSI, LNI, TS, PI, RM	6
Obrzut 2017 []¹¹³	Poland	Pro	102	48.0	I–II	10.0	OS, DFS	FIGO, CT, TG, LNI, LVSI, RM	6
Cho 2017 []¹¹⁴	Korea	Retro	105	NA	II	4.8	PFS	Age, CT, TS, LNI, NLR	5
Chandeying 2017 []¹¹⁵	Thailand	Retro	626	45.0	I	7.7	OS, DFS	CT, age, TS, FIGO, RM, PI, LNI, LVSI, DI	7
Yokoi 2017 []¹¹⁶	Japan	Retro	249	61.5	II–IV	5.0	PFS	Age, FIGO, LNI, CT, He	7
Lim 2017 []¹¹⁷	Korea	Retro	180	NA	I–II	5.0	OS, DFS	PI, LNI	5
Xu 2018 []¹¹⁸	China	Retro	40	45.5	I–IV	5.0	OS	Age, FIGO, LNI, LVSI, DI, TS	6
Wen 2018 []¹¹⁹	China	Retro	99	NA	II–IV	4.0	DFS	Age, TS, CT, FIGO, SCC, PI	6
Joo 2018 []¹²⁰	Korea	Retro	397	45.0	I–II	4.0	OS, DFS	CT, FIGO, LNI, PI, LVSI, DI, TS	6
Dai 2018 []¹²¹	China	Retro	302	45.1	I–II	5.0	OS	FIGO, TS, TG, DI, LVSI, PI, LNI	6
Zhu 2018 []¹²²	China	Retro	365	45.0	I–II	3.7	OS, PFS	Age, DI, LNI, LVSI, PI	5
Zhou 2018 []¹²³	China	Retro	312	46.0	I–II	4.7	OS, DFS	Age, FIGO, TS, TG, DI, LVSI, LNI	5
Liu 2018 []¹²⁴	China	Retro	98	52.0	I–III	3.1	OS, PFS	TS, LNI	5
Xie 2018 []¹²⁵	China	Retro	810	46.3	I–II	5.0	OS	FIGO, LNI	5
Taarnhøj 2018 []¹²⁶	Denmark	Retro	1,523	NA	I	5.0	DFS	FIGO, CT, age, DI, LVSI	6
Zhang 2018 []¹²⁷	China	Retro	235	46.0	I–II	6.4	OS, PFS	Age, FIGO, TS, CT, LVSI, LNI, DI, NLR	7
Je 2018 []¹²⁸	Korea	Retro	1,069	49.0	I–II	5.0	DFS	CT, PI, LVSI, DI, TS, LNI	7
Ishikawa 2018 []¹²⁹	Japan	Retro	93	NA	I–II	10.0	OS, DFS	CT, TS, DI, LVSI, PI, LNI, RM	6
Kwon 2018 []¹³⁰	Korea	Retro	259	47.0	I–II	5.8	DFS	CT, LVSI	6
Zhu 2019 []¹³¹	China	Retro	110	51.5	I–II	4.0	OS, PFS	Age, TS, LNI, FIGO, TG, Ly	6
Yan 2019 []¹³²	China	Retro	347	NA	I–II	3.3	OS, PFS	Age, FIGO, LNI, TG, LVSI, DI	6
Wang 2019 []¹³³	China	Retro	559	51.0	I–IV	3.3	DFS	Age, SCC, FIGO, TS, LNI	7
Farzaneh 2019 []¹³⁴	Iran	Retro	307	40.4	I–III	5.0	DFS	RM, NLR	5
Sawada 2019 []¹³⁵	Japan	Retro	107	46.0	I–II	4.8	OS	FIGO, CT, TS, LNI, PI	6
Khalkhali 2019 []¹³⁶	Iran	Retro	109	50.1	I–IV	3.2	OS	Age, FIGO	5
Yildirim 2019 []¹³⁷	Turkey	Retro	104	56.0	I–IV	4.4	OS, DFS	TS, FIGO, LNI	6
Gai 2019 []¹³⁸	China	Retro	79	51.0	I–IV	5.0	OS	FIGO, LNI, LVSI	6
Chen 2019 []¹³⁹	China	Retro	88	48.0	I–II	2.2	DFS	Age, CT, FIGO, TG, LVSI	5
Guani 2019 []¹⁴⁰	France	Pro	139	NA	I	3.0	DFS	LNI, CT, TS, FIGO, LVSI, age	5
Huang 2019 []¹⁴¹	China	Retro	458	45.0	I–II	3.9	OS	Age, TG, TS, LNI, LVSI, FIGO, NLR	7
Queiroz 2019 []¹⁴²	Brazil	Retro	127	50.8	II–IV	4.1	OS, DFS	Age, CT, TS, LNI	5
Gillani 2019 []¹⁴³	Malaysia	Pro	3,797	57.3	I–II	6.1	OS	Age, FIGO, TS, LNI, CT	6
de Foucher 2019 []¹⁴⁴	France	Retro	501	54.0	I–II	3.0	OS, DFS	FIGO, LNI	6
Yoshino 2019 []¹⁴⁵	Japan	Retro	128	65.0	I–IV	2.5	OS	FIGO, CT	6
Zhang 2019 []¹⁴⁶	China	Retro	89	40.5	I–IV	4.8	OS	FIGO, TS, LNI, LVSI, DI	6
Seebacher 2019 []¹⁴⁷	Austria	Retro	116	52.1	I–IV	1.7	OS	Age, FIGO, CT, SCC	5
Holub 2019 []¹⁴⁸	Spain	Retro	151	52.8	I–IV	3.7	OS	TS, FIGO, age, NLR	6
Theplib 2020 []¹⁴⁹	Thailand	Retro	196	41.0	I	5.0	OS, DFS	LVSI, PI, LNI, DI	6
Maulard 2020 []¹⁵⁰	France	Pro	238	45.9	I–IV	4.4	OS	FIGO, CT, LNI	7
An 2020 []¹⁵¹	China	Retro	278	45.5	I–II	5.0	OS, DFS	Age, CT, FIGO, TG, TS, LVSI, LNI, DI, RM, He	6
Casarin 2020 []¹⁵²	Italy	Retro	428	45.0	I	4.7	DFS	TS, LVSI, TG, LNI	7
Wang 2020 []¹⁵³	China	Retro	120	59.0	I–III	3.2	OS	LNI, age, FIGO, TG, TS	6
Zyla 2020 []¹⁵⁴	Canada	Retro	285	41.0	I	4.0	OS, DFS	TG, CT, LVSI	6
He 2020 []¹⁵⁵	China	Retro	1,414	NA	I–II	3.6	OS, DFS	Age, FIGO, TS, CT, TG, DI, LVSI, PI, RM, LNI	7
Zeng 2020 []¹⁵⁶	China	Retro	251	46.0	I–III	3.9	OS, DFS	FIGO, LNI	6
Liu 2020 []¹⁵⁷	China	Retro	73	NA	I–II	5.7	OS	Age, CT, FIGO, TG, TS, SCC	5
Kim 2020 []¹⁵⁸	Korea	Retro	47	45.0	I–II	2.4	OS, DFS	FIGO, SCC, DI, RM, PI, LNI, LVSI	5
Anfinan 2020 []¹⁵⁹	Saudi Arabia	Retro	190	54.2	I–IV	3.1	OS	FIGO, TG, PI	6
Lee 2020 []¹⁶⁰	Korea	Retro	125	53.7	II–III	4.2	OS, DFS	Age, CT, TS, FIGO, LNI, SCC, NLR	5
Zong 2020 []¹⁶¹	China	Retro	384	46.3	I–II	3.6	OS, DFS	Age, FIGO, TG, TS, PI, LVSI, DI, RM	6
Aslan 2020 []¹⁶²	Turkey	Retro	185	50.0	III	3.8	OS, DFS	Age, CT, DI, PI, TS, LVSI, RM, FIGO	7
Gülseren 2020 []¹⁶³	Turkey	Retro	194	NA	I–II	5.0	DFS	FIGO, TS, PI, LVSI	6
Kim 2021 []¹⁶⁴	Korea	Retro	55	52.6	I–II	4.5	DFS	Age, FIGO, PI, RM	7
Okadome 2021 []¹⁶⁵	Japan	Retro	82	NA	II	5.8	DFS	CT, LNI, TS	6
Buda 2021 []¹⁶⁶	Italy	Retro	573	45.5	I–II	3.8	DFS	Age, CT, FIGO, LVSI	6
CT – cell type; DI – depth of invasion; He – hemoglobin; Retro – retrospective; Pro – prospective; PI – parametrial invasion; Le – leukocytosis; LVSI – lymph vascular space invasion; LNI – lymph node involvement; Ly – lymphocyte; RM – resection margin; SCC – squamous cell carcinoma antigen; TG – tumor grade; Th – thrombocytosis; TS – tumor size; TV – tumor volume; NA – not available; NLR – neutrophil/lymphocyte ratio.

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Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

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