The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: a meta-analysis

Wing-Keen Yap; Ken-Hao Hsu; Ting-Hao Wang; Chia-Hsin Lin; Chung-Jan Kang; Shih-Ming Huang; Huan-Chun Lin; Tsung-Min Hung; Kai-Ping Chang; Tsung-You Tsai

doi:10.1007/s12149-024-01933-5

The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: a meta-analysis

Ann Nucl Med. 2024 May 9. doi: 10.1007/s12149-024-01933-5. Online ahead of print.

Authors

Affiliations

¹ Proton and Radiation Therapy Center, Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University, Taoyuan, 333423, Taiwan.
² Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St. Kwei-Shan, Taoyuan, 333423, Taiwan.
³ Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
⁴ Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan.
⁵ College of Medicine, Chang Gung University, Taoyuan, 333323, Taiwan.
⁶ Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St. Kwei-Shan, Taoyuan, 333423, Taiwan. J-acky_101@hotmail.com.

^# Contributed equally.

PMID: 38724805
DOI: 10.1007/s12149-024-01933-5

Abstract

Objective: The lymph node to primary tumor standardized uptake value ratio (NTR) is an innovative parameter derived from positron emission tomography/computed tomography (PET/CT) scans that captures the intricate relationship between primary tumors and associated lymph nodes. This meta-analysis aimed to investigate the prognostic value of NTR in cancer patients.

Methods: A systematic search of PubMed, Cochrane, and Embase databases was conducted to identify studies investigating the association between NTR and survival outcomes in cancer patients. The pooled adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Twelve studies comprising a total of 2037 patients were included in the meta-analysis. Elevated NTR was significantly associated with worse overall survival aHR (2.21, 95% CI 1.63 to 2.99), disease-free survival aHR (3.27, 95% CI 2.12 to 5.05), and distant metastasis-free survival aHR (2.07, 95% CI 1.55 to 2.78) in cancer patients. Subgroup analyses by cancer type showed consistent results across various malignancies, including head and neck squamous cell carcinoma, endometrial carcinoma, lung cancer, breast cancer, and nasopharyngeal carcinoma.

Conclusions: This meta-analysis provides evidence for a significant association between elevated NTR and worse survival outcomes in cancer patients. Elevated NTR may serve as a useful prognostic biomarker for cancer patients and could potentially be used to guide treatment decisions and monitor disease progression. Future studies should aim to validate these findings in larger and more diverse patient populations and investigate the underlying mechanisms for the observed association between NTR and survival outcomes.

Keywords: Cancer; Meta-analysis; NTR; Node-to-primary tumor SUV ratio; PET; Prognosis.