Prognostic value of lymphocyte to monocyte ratio for cervical cancer: a systematic review and meta-analysis
Guanjun Zhao1, Masmuha Marshed Al Ramadhan1, Yifang Zhang1
1Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China.
Background:
Systemic inflammatory biomarkers have been associated with outcomes across multiple malignancies, including cervical cancer. The prognostic value of the pretreatment lymphocyte-to-monocyte ratio (LMR) in cervical cancer remains inconsistent across published studies. We therefore performed a systematic review and meta-analysis to clarify the association between pretreatment LMR and survival outcomes in cervical cancer.
Methods:
PubMed, Web of Science, Embase, and the Cochrane Library were searched from database inception to November 14, 2025. Studies evaluating pretreatment LMR in relation to survival outcomes in cervical cancer were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled for overall survival (OS) and progression-free survival (PFS). Subgroup, sensitivity, meta-regression, and publication-bias analyses were also performed.
Results:
Eighteen studies comprising 22 independent cohorts (n = 5,127) were included. Low pretreatment LMR was associated with poorer OS in both univariable (HR = 1.94, 95% CI [1.58-2.38]) and multivariable analyses (HR = 1.66, 95% CI [1.40-1.96]), and with poorer PFS in both univariable (HR = 2.26, 95% CI [1.77-2.90]) and multivariable analyses (HR = 2.07, 95% CI [1.47-2.90]). In multivariable subgroup analyses, the adverse OS association remained evident in patients aged <50 years, in studies using an LMR cut-off <3.85, and in cohorts treated primarily with surgery. Meta-regression further indicated that study-specific LMR cut-off values were significantly associated with OS effect estimates.
Conclusions:
Current evidence suggests that a low pretreatment LMR is significantly associated with poorer OS and PFS in cervical cancer. Pretreatment LMR may therefore represent an accessible and cost-effective biomarker for pretreatment risk stratification. Nevertheless, prospective studies are warranted to validate clinically meaningful cut-off values, standardize analytical approaches, and further define the clinical utility of LMR in cervical cancer.