Low pretreatment lymphocyte-to-monocyte ratio linked to worse survival in cervical cancer

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PeerJ Published June 6, 2026 Medically reviewed June 6, 2026 Study authors: Zhao Guanjun, Al Ramadhan Masmuha Marshed, Zhang Yifang PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider pretreatment LMR as a potential prognostic biomarker in cervical cancer, but await prospective validation.

This systematic review and meta-analysis evaluated the prognostic value of pretreatment lymphocyte-to-monocyte ratio (LMR) in patients with cervical cancer. The analysis included 5,127 patients across multiple studies. The primary outcomes were overall survival (OS) and progression-free survival (PFS).

Low pretreatment LMR was significantly associated with poorer OS in univariable analysis (HR = 1.94, 95% CI 1.58-2.38) and multivariable analysis (HR = 1.66, 95% CI 1.40-1.96). Similarly, low LMR was associated with worse PFS in univariable (HR = 2.26, 95% CI 1.77-2.90) and multivariable analyses (HR = 2.07, 95% CI 1.47-2.90).

The authors note that 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. The review did not report on adverse events or treatment-related outcomes.

Pretreatment LMR may represent an accessible and cost-effective biomarker for pretreatment risk stratification, but the evidence is based on associations, and clinical utility requires prospective validation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up600.0 mo

PublishedJan 2026

PMID42222483

View Original Abstract ↓

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 ( = 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.