BACKGROUND: The ratio of harvested lymph nodes to the number of metastatic nodes is known as the lymph node ratio (LNR) and its prognostic significance was investigated in many types of cancer. OBJECTIVES: However, until now, the therapeutic role of lymphadenectomy in the management of endometrial cancer (EC) has remained controversial. SEARCH STRATEGY: The search strategy involved the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases. SELECTION CRITERIA: We included prospective and retrospective observational studies. DATA COLLECTION AND ANALYSIS: The current systematic review includes seven studies with a total of 6050 patients. From Cox regression analyses, pooled hazard ratios (HRs) were obtained to reduce the confounding effect of other factors that affect the survival outcomes. MAIN RESULTS: The meta-analysis revealed a significant difference in progression-free survival in patients with LNR below the cut-off point in comparison to individuals with LNR above the cut-off point (HR 2.06, 95% CI 1.57-2.71, data from 6 studies). Similarly, a significantly smaller overall survival was observed among patients with LNR above the cut-off value (HR 1.99, 95% CI 1.53-2.60
data from five studies). CONCLUSIONS: The results of this systematic review provide strong evidence that LNR could be a prognostic factor for EC patients regarding the need for adjuvant therapy and survival rate. Further studies should focus on the specific cut-off levels of LNR and the role of the molecular markers in assessing the prognosis of EC patients.