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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Table 2 Subgroup analysis for overall survival and event-free survival based on countries, FIGO stage, and cutoff value.

Prognostic factors	Outcome	Variables	Subgroups	HR and 95% CI	P value	I2 (%)	Q statistic	P value between subgroups
Age	OS	Countries	Eastern	1.11 (1.00–1.23)	0.052	61.8	<0.001	0.703
		Countries	Western	1.08 (0.86–1.36)	0.489	72.0	<0.001	0.703
		FIGO stage	I–II	1.23 (1.10–1.38)	<0.001	56.2	<0.001	0.070
			III–IV	1.13 (0.76–1.69)	0.539	0.0	0.719
			Both	0.94 (0.79–1.13)	0.524	72.7	<0.001
		Cutoff value	≥50.0	1.09 (0.97–1.23)	0.162	68.2	<0.001	0.592
		Cutoff value	<50.0	1.13 (0.96–1.33)	0.140	58.4	<0.001	0.592
		Study quality	High	1.03 (0.86–1.24)	0.723	71.9	<0.001	0.206
		Study quality	Low	1.15 (1.03–1.28)	0.016	59.8	<0.001	0.206
	EFS	Countries	Eastern	1.19 (1.02–1.38)	0.024	67.4	<0.001	0.082
		Countries	Western	1.40 (0.99–1.98)	0.061	67.5	0.002	0.082
		FIGO stage	I–II	1.31 (1.13–1.52)	<0.001	56.3	<0.001	<0.001
			III–IV	0.91 (0.59–1.40)	0.666	–	–
			Both	1.03 (0.76–1.39)	0.864	77.7	<0.001
		Cutoff value	≥50.0	1.23 (1.04–1.46)	0.016	70.1	<0.001	0.022
		Cutoff value	<50.0	1.20 (0.96–1.51)	0.116	59.0	0.001	0.022
		Study quality	High	0.90 (0.76–1.08)	0.251	65.2	<0.001	<0.001
		Study quality	Low	1.49 (1.29–1.73)	<0.001	37.6	0.019	<0.001
Cell type	OS	Countries	Eastern	1.74 (1.52–1.98)	<0.001	39.9	0.007	0.047
		Countries	Western	1.44 (1.20–1.73)	<0.001	18.6	0.231	0.047
		FIGO stage	I–II	1.65 (1.43–1.91)	<0.001	24.2	0.120	0.963
			III–IV	1.58 (0.89–2.78)	0.115	0.0	0.521
			Both	1.63 (1.36–1.95)	<0.001	51.3	0.002
		Study quality	High	1.79 (1.53–2.09)	<0.001	42.6	0.015	0.049
		Study quality	Low	1.50 (1.29–1.74)	<0.001	26.5	0.090	0.049
	EFS	Countries	Eastern	1.68 (1.43–1.97)	<0.001	62.9	<0.001	0.008
		Countries	Western	1.50 (1.18–1.91)	0.001	58.8	0.001	0.008
		FIGO stage	I–II	1.56 (1.31–1.86)	<0.001	65.2	<0.001	0.490
			III–IV	2.33 (1.38–3.94)	0.002	–	–
			Both	1.71 (1.37–2.13)	<0.001	59.8	0.001
		Study quality	High	1.88 (1.57–2.24)	<0.001	67.4	<0.001	0.004
		Study quality	Low	1.43 (1.17–1.74)	<0.001	56.7	<0.001	0.004
Depth of invasion	OS	Countries	Eastern	2.09 (1.66–2.63)	<0.001	59.1	<0.001	0.024
		Countries	Western	1.11 (0.52–2.38)	0.790	75.3	0.003	0.024
		FIGO stage	I–II	2.09 (1.65–2.63)	<0.001	62.1	<0.001	0.015
			III–IV	0.89 (0.42–1.89)	0.761	–	–
			Both	1.01 (0.43–2.37)	0.979	58.9	0.088
		Cutoff value	≥1/2	2.02 (1.59–2.57)	<0.001	37.2	0.053	0.782
		Cutoff value	<1/2	1.73 (1.15–2.61)	0.009	77.1	<0.001	0.782
		Study quality	High	1.75 (1.20–2.55)	0.004	67.5	0.001	0.680
		Study quality	Low	2.02 (1.51–2.40)	<0.001	62.6	<0.001	0.680
	EFS	Countries	Eastern	1.83 (1.60–2.09)	<0.001	28.1	0.070	0.010
		Countries	Western	1.29 (0.75–2.22)	0.359	80.7	<0.001	0.010
		FIGO stage	I–II	1.77 (1.52–2.06)	<0.001	51.6	<0.001	0.054
			III–IV	0.93 (0.51–1.71)	0.815	–	–
			Both	0.86 (0.32–2.31)	0.765	–	–
		Cutoff value	≥1/2	1.67 (1.39–2.00)	<0.001	43.8	0.019	0.549
		Cutoff value	<1/2	1.77 (1.37–2.29)	<0.001	60.5	<0.001	0.549
		Study quality	High	1.64 (1.23–2.18)	0.001	69.1	<0.001	0.596
		Study quality	Low	1.77 (1.49–2.09)	<0.001	34.6	0.047	0.596
FIGO stage	OS	Countries	Eastern	1.86 (1.62–2.14)	<0.001	84.1	<0.001	<0.001
		Countries	Western	2.36 (1.73–3.21)	<0.001	85.9	<0.001	<0.001
		FIGO stage	I–II	1.60 (1.41–1.82)	<0.001	73.4	<0.001	<0.001
			III–IV	1.47 (0.85–2.54)	0.168	–	–
			Both	2.51 (2.04–3.09)	<0.001	81.7	<0.001
		Cutoff value	IA or IB	1.92 (1.65–2.23)	<0.001	87.6	<0.001	<0.001
		Cutoff value	II–III	2.24 (1.78–2.81)	<0.001	64.9	<0.001	<0.001
		Study quality	High	2.40 (1.87–3.07)	<0.001	86.9	<0.001	<0.001
		Study quality	Low	1.80 (1.57–2.06)	<0.001	78.9	<0.001	<0.001
	EFS	Countries	Eastern	1.83 (1.60–2.08)	<0.001	69.1	<0.001	0.355
		Countries	Western	1.97 (1.61–2.41)	<0.001	62.4	<0.001	0.355
		FIGO stage	I–II	1.70 (1.50–1.93)	<0.001	52.6	<0.001	0.001
			III–IV	1.01 (0.55–1.83)	0.984	–	–
			Both	2.11 (1.75–2.54)	<0.001	75.5	<0.001
		Cutoff value	IA or IB	1.80 (1.59–2.04)	<0.001	68.1	<0.001	0.021
		Cutoff value	II–III	2.04 (1.65–2.52)	<0.001	62.5	<0.001	0.021
		Study quality	High	1.70 (1.45–2.00)	<0.001	73.9	<0.001	0.023
		Study quality	Low	1.99 (1.72–2.31)	<0.001	61.3	<0.001	0.023
Hemoglobin	OS	Countries	Eastern	1.56 (1.15–2.10)	0.004	58.1	0.019	0.001
		Countries	Western	3.05 (2.01–4.64)	<0.001	0.0	0.608	0.001
		FIGO stage	I–II	1.39 (0.99–1.95)	0.061	0.0	0.898	0.720
			III–IV	1.81 (0.90–3.64)	0.097	-	-
			Both	2.07 (1.34–3.19)	0.001	75.7	<0.001
		Cutoff value	10	1.94 (1.13–3.36)	0.017	80.2	<0.001	0.156
		Cutoff value	>10	1.77 (1.39–2.27)	<0.001	0.0	0.688	0.156
		Study quality	High	2.01 (1.00–4.04)	0.050	88.0	<0.001	0.337
		Study quality	Low	1.70 (1.33–2.17)	<0.001	0.0	0.740	0.337
	EFS	Countries	Eastern	1.20 (1.07–1.34)	0.002	4.3	0.401	0.004
		Countries	Western	2.25 (1.48–3.41)	<0.001	0.0	0.580	0.004
		FIGO stage	I–II	1.58 (1.19–2.09)	0.001	0.0	0.778	0.071
			III–IV	–	–	–	–
			Both	1.24 (1.03–1.50)	0.022	53.6	0.044
		Cutoff value	10	1.50 (1.11–2.04)	0.009	58.9	0.023	0.248
		Cutoff value	>10	1.19 (1.04–1.35)	0.010	0.0	0.733	0.248
		Study quality	High	1.30 (0.86–1.96)	0.216	67.5	0.026	0.718
		Study quality	Low	1.29 (1.12–1.50)	0.001	18.5	0.284	0.718
Histological grade	OS	Countries	Eastern	1.56 (1.24–1.96)	<0.001	56.3	0.004	0.460
		Countries	Western	1.48 (1.08–2.02)	0.014	55.0	0.011	0.460
		FIGO stage	I–II	1.44 (1.19–1.74)	<0.001	41.6	0.030	0.414
			III–IV	–	–	–	–
			Both	1.75 (1.13–2.72)	0.012	72.6	0.001
		Cutoff value	1	1.52 (1.20–1.92)	0.001	61.8	<0.001	0.424
		Cutoff value	2	1.56 (1.17–2.07)	0.002	32.6	0.157	0.424
		Study quality	High	1.43 (1.16–1.76)	0.001	29.1	0.160	0.839
		Study quality	Low	1.62 (1.20–2.19)	0.001	66.2	<0.001	0.839
	EFS	Countries	Eastern	1.47 (1.09–1.97)	0.011	73.4	<0.001	0.377
		Countries	Western	1.38 (1.07–1.78)	0.013	44.0	0.051	0.377
		FIGO stage	I–II	1.49 (1.17–1.89)	0.001	66.7	<0.001	0.340
			III–IV	–	–	–	–
			Both	1.24 (0.99–1.57)	0.066	0.0	0.517
		Cutoff value	1	1.47 (1.13–1.90)	0.004	72.5	<0.001	0.746
		Cutoff value	2	1.41 (1.15–1.73)	0.001	0.0	0.447	0.746
		Study quality	High	1.43 (1.12–1.84)	0.005	64.5	0.001	0.308
		Study quality	Low	1.45 (1.05–2.01)	0.025	58.7	0.013	0.308
Leukocytosis	OS	Countries	Eastern	2.20 (1.48–3.26)	<0.001	75.2	0.001	0.726
		Countries	Western	2.46 (1.15–5.26)	0.020	-	-	0.726
		FIGO stage	I–II	1.55 (1.16–2.05)	0.003	0.0	0.623	0.013
			III–IV	3.04 (1.52–6.07)	0.002	-	-
			Both	2.66 (1.53–4.64)	0.001	73.7	0.010
		Cutoff value	≥10000	2.05 (1.25–3.35)	0.004	50.6	0.132	0.242
		Cutoff value	<10000	2.35 (1.39–4.00)	0.002	79.8	0.002	0.242
		Study quality	High	1.74 (1.18–2.56)	0.005	9.6	0.293	0.148
		Study quality	Low	2.41 (1.51–3.85)	<0.001	76.6	0.002	0.148
	EFS	Countries	Eastern	2.08 (1.25–3.45)	0.005	69.6	0.011	–
		Countries	Western	–	–	–	–	–
		FIGO stage	I–II	1.66 (0.52–5.26)	0.389	–	–	0.642
			III–IV	–	–	–	–
			Both	2.14 (1.20–3.81)	0.010	76.8	0.005
		Cutoff value	≥10000	1.63 (0.66–4.05)	0.290	0.0	0.964	0.526
		Cutoff value	<10000	2.22 (1.16–4.24)	0.016	84.3	0.002	0.526
		Study quality	High	2.10 (1.62–2.74)	<0.001	–	–	0.685
		Study quality	Low	2.00 (0.86–4.65)	0.109	76.9	0.005	0.685
LNI	OS	Countries	Eastern	2.49 (2.17–2.85)	<0.001	71.4	<0.001	0.007
		Countries	Western	2.90 (2.29–3.67)	<0.001	60.5	<0.001	0.007
		FIGO stage	I–II	2.97 (2.57–3.43)	<0.001	65.8	<0.001	0.001
			III–IV	–	–	–	–
			Both	2.04 (1.66–2.51)	<0.001	72.3	<0.001
		Study quality	High	2.52 (2.08–3.04)	<0.001	68.5	<0.001	0.639
		Study quality	Low	2.64 (2.26–3.09)	<0.001	70.7	<0.001	0.639
	EFS	Countries	Eastern	2.37 (2.03–2.77)	<0.001	81.0	<0.001	0.001
		Countries	Western	2.18 (1.75–2.72)	<0.001	61.6	<0.001	0.001
		FIGO stage	I–II	2.54 (2.14–3.01)	<0.001	81.8	<0.001	0.998
			III–IV	–	–	–	–
			Both	1.89 (1.57–2.26)	<0.001	61.5	<0.001
		Study quality	High	2.16 (1.73–2.70)	<0.001	87.0	<0.001	<0.001
		Study quality	Low	2.40 (2.10–2.75)	<0.001	51.3	<0.001	<0.001
LVSI	OS	Countries	Eastern	1.99 (1.64–2.43)	<0.001	63.2	<0.001	0.036
		Countries	Western	2.49 (1.72–3.60)	<0.001	36.3	0.100	0.036
		FIGO stage	I–II	2.08 (1.70–2.55)	<0.001	64.6	<0.001	0.539
			III–IV	2.10 (0.32–13.68)	0.438	–	–
			Both	2.20 (1.66–2.90)	<0.001	0.0	0.976
		Study quality	High	1.78 (1.41–2.24)	<0.001	47.4	0.029	0.046
		Study quality	Low	2.30 (1.80–2.94)	<0.001	62.0	<0.001	0.046
	EFS	Countries	Eastern	1.87 (1.62–2.16)	<0.001	48.0	0.001	<0.001
		Countries	Western	1.80 (1.33–2.46)	<0.001	80.5	<0.001	<0.001
		FIGO stage	I–II	1.92 (1.68–2.18)	<0.001	51.1	<0.001	<0.001
			III–IV	0.94 (0.36–2.44)	0.899	–	–
			Both	1.02 (0.95–1.09)	0.572	–	–
		Study quality	High	1.77 (1.34–2.32)	<0.001	85.6	<0.001	<0.001
		Study quality	Low	1.91 (1.63–2.23)	<0.001	43.0	0.004	<0.001
NLR	OS	Countries	Eastern	1.48 (1.23–1.79)	<0.001	52.9	0.038	0.001
		Countries	Western	2.50 (1.39–4.50)	0.002	50.5	0.155	0.001
		FIGO stage	I–II	1.78 (1.37–2.31)	<0.001	0.0	0.476	0.004
			III–IV	-	–	–	–
			Both	1.62 (1.22–2.14)	0.001	72.7	0.003
		Cutoff value	≥3.0	2.40 (1.75–3.28)	<0.001	0.0	0.494	<0.001
		Cutoff value	<3.0	1.35 (1.15–1.59)	<0.001	41.1	0.131	<0.001
		Study quality	High	1.58 (1.23–2.03)	<0.001	75.7	0.001	0.005
		Study quality	Low	2.04 (1.43–2.92)	<0.001	0.0	0.926	0.005
	EFS	Countries	Eastern	1.56 (1.23–1.98)	<0.001	76.6	<0.001	<0.001
		Countries	Western	3.58 (2.11–6.08)	<0.001	–	–	<0.001
		FIGO stage	I–II	1.99 (1.51–2.63)	<0.001	0.0	0.816	<0.001
			III–IV	-	–	–	–
			Both	1.61 (1.17–2.21)	0.003	86.1	<0.001
		Cutoff value	≥3.0	2.12 (1.28–3.52)	0.004	58.4	0.065	<0.001
		Cutoff value	< 3.0	1.51 (1.16–1.98)	0.002	81.7	<0.001	<0.001
		Study quality	High	1.65 (1.16–2.36)	0.006	85.8	<0.001	<0.001
		Study quality	Low	1.85 (1.24–2.78)	0.003	60.6	0.038	<0.001
Parametrial invasion	OS	Countries	Eastern	2.16 (1.81–2.58)	<0.001	31.7	0.060	0.828
		Countries	Western	2.26 (1.44–3.55)	<0.001	67.5	0.001	0.828
		FIGO stage	I–II	2.15 (1.81–2.55)	<0.001	31.4	0.053	0.024
			III–IV	1.11 (0.53–2.32)	0.782	–	–
			Both	2.26 (1.31–3.89)	0.003	68.9	0.007
		Study quality	High	1.90 (1.36–2.66)	<0.001	66.1	0.001	0.050
		Study quality	Low	2.36 (1.96–2.64)	<0.001	22.9	0.146	0.050
	EFS	Countries	Eastern	1.89 (1.63–2.21)	<0.001	37.6	0.019	0.948
		Countries	Western	2.03 (1.66–2.21)	<0.001	58.0	0.015	0.948
		FIGO stage	I–II	1.96 (1.68–2.28)	<0.001	42.7	0.005	0.153
			III–IV	3.70 (1.14–11.96)	0.029	–	–
			Both	1.48 (1.01–2.15)	0.044	24.9	0.262
		Study quality	High	1.54 (1.32–1.80)	<0.001	12.1	0.321	<0.001
		Study quality	Low	2.23 (1.86–2.69)	<0.001	32.7	0.056	<0.001
PLR	OS	Countries	Eastern	2.20 (1.62–3.00)	<0.001	0.0	0.531	0.101
		Countries	Western	1.54 (0.73–3.25)	0.260	69.8	0.069	0.101
		FIGO stage	I–II	2.10 (1.51–2.91)	<0.001	0.0	0.486	0.342
			III–IV	–	–	–	–
			Both	1.86 (0.97–3.59)	0.062	65.6	0.055
		Cutoff value	≥150	2.59 (1.68–3.99)	<0.001	0.0	0.862	0.081
		Cutoff value	<150	1.72 (1.12–2.65)	0.014	48.4	0.121	0.081
		Study quality	High	1.55 (0.98–2.43)	0.059	45.1	0.162	0.033
		Study quality	Low	2.54 (1.76–3.66)	<0.001	0.0	0.805	0.033
	EFS	Countries	Eastern	2.47 (1.80–3.38)	<0.001	0.0	0.914	0.004
		Countries	Western	1.01 (0.60–1.70)	0.973	–	–	0.004
		FIGO stage	I–II	2.44 (1.71–3.48)	<0.001	0.0	0.779	0.058
			III–IV	–	–	–	–
			Both	1.58 (0.63–3.95)	0.333	78.8	0.030
		Cutoff value	≥150	2.59 (1.58–4.23)	<0.001	0.0	0.992	0.174
		Cutoff value	<150	1.82 (0.96–3.46)	0.069	71.3	0.030	0.174
		Study quality	High	1.56 (0.62–3.93)	0.343	76.7	0.038	0.045
		Study quality	Low	2.44 (1.72–3.46)	<0.001	0.0	0.779	0.045
Resection margin	OS	Countries	Eastern	1.88 (1.29–2.75)	0.001	65.7	0.002	0.268
		Countries	Western	2.22 (1.25–3.95)	0.006	44.1	0.111	0.268
		FIGO stage	I–II	1.89 (1.36–2.62)	<0.001	57.3	0.004	0.050
			III–IV	1.55 (0.86–2.81)	0.148	–	–
			Both	5.49 (2.09–14.41)	0.001	–	–
		Study quality	High	2.13 (1.24–3.66)	0.006	74.6	<0.001	0.569
		Study quality	Low	1.75 (1.27–2.40)	0.001	18.3	0.285	0.569
	EFS	Countries	Eastern	2.16 (1.56–2.99)	<0.001	52.2	0.006	0.129
		Countries	Western	1.69 (1.20–2.37)	0.003	39.3	0.106	0.129
		FIGO stage	I–II	1.86 (1.43–2.43)	<0.001	45.2	0.012	0.005
			III–IV	1.71 (1.20–2.43)	0.003	0.0	0.925
			Both	5.62 (2.78–11.37)	<0.001	0.0	0.795
		Study quality	High	1.80 (1.33–2.45)	<0.001	53.3	0.015	0.218
		Study quality	Low	2.26 (1.53–3.33)	<0.001	45.7	0.032	0.218
SCC	OS	Countries	Eastern	1.72 (1.26–2.35)	0.001	42.0	0.078	0.884
		Countries	Western	1.50 (0.92–2.45)	0.105	–	–	0.884
		FIGO stage	I–II	1.81 (1.22–2.68)	0.003	0.0	0.737	0.259
			III–IV	1.00 (0.55–1.82)	0.992	–	–
			Both	1.97 (1.25–3.10)	0.003	63.1	0.028
		Cutoff value	≥10	1.39 (0.76–2.53)	0.288	20.4	0.285	0.654
		Cutoff value	<10	1.77 (1.29–2.42)	<0.001	45.4	0.076	0.654
		Study quality	High	2.61 (1.42–4.83)	0.002	37.0	0.204	0.019
		Study quality	Low	1.36 (1.15–1.60)	<0.001	0.0	0.440	0.019
	EFS	Countries	Eastern	1.80 (1.33–2.45)	<0.001	43.7	0.087	–
		Countries	Western	–	–	–	–	–
		FIGO stage	I–II	1.17 (0.61–2.22)	0.637	34.4	0.218	0.079
			III–IV	–	–	–	–
			Both	2.08 (1.51–2.87)	<0.001	36.6	0.177
		Cutoff value	≥10	1.63 (0.56–4.76)	0.370	77.4	0.035	0.954
		Cutoff value	<10	1.83 (1.33–2.53)	<0.001	37.6	0.156	0.954
		Study quality	High	1.70 (1.14–2.56)	0.010	52.4	0.122	0.469
		Study quality	Low	1.86 (1.12–3.11)	0.017	48.2	0.102	0.469
Tumor grade	OS	Countries	Eastern	2.00 (1.37–2.93)	<0.001	61.5	0.016	0.007
		Countries	Western	1.07 (0.78–1.45)	0.678	0.0	0.899	0.007
		FIGO stage	I–II	2.00 (1.37–2.93)	<0.001	61.5	0.016	0.007
			III–IV	–	–	–	–
			Both	1.07 (0.78–1.45)	0.678	0.0	0.899
		Study quality	High	1.67 (0.90–3.10)	0.101	–	–	0.721
		Study quality	Low	1.76 (1.21–2.57)	0.003	69.4	0.002	0.721
	EFS	Countries	Eastern	1.39 (1.14–1.71)	0.001	39.2	0.130	0.480
		Countries	Western	1.16 (0.60–2.26)	0.661	11.6	0.288	0.480
		FIGO stage	I–II	1.41 (1.17–1.70)	<0.001	30.3	0.186	0.226
			III–IV	–	–	–	–
			Both	0.89 (0.41–1.94)	0.769	–	–
		Study quality	High	1.35 (0.96–1.89)	0.084	54.1	0.113	0.754
		Study quality	Low	1.38 (1.05–1.82)	0.021	29.1	0.217	0.754
Tumor size	OS	Countries	Eastern	1.76 (1.52–2.05)	<0.001	71.7	<0.001	0.004
		Countries	Western	1.95 (1.51–2.53)	<0.001	59.9	0.001	0.004
		FIGO stage	I–II	1.66 (1.41–1.97)	<0.001	70.6	<0.001	<0.001
			III–IV	1.09 (0.55–2.15)	0.811	45.3	0.176
			Both	2.17 (1.78–2.65)	<0.001	59.1	<0.001
		Cutoff value	≥4.0 cm	1.72 (1.48–2.00)	<0.001	69.6	<0.001	<0.001
		Cutoff value	<4.0 cm	2.09 (1.61–2.70)	<0.001	64.8	<0.001	<0.001
		Study quality	High	1.87 (1.52–2.31)	<0.001	66.1	<0.001	0.010
		Study quality	Low	1.78 (1.51–2.11)	<0.001	70.7	<0.001	0.010
	EFS	Countries	Eastern	1.70 (1.46–1.98)	<0.001	77.8	<0.001	<0.001
		Countries	Western	1.67 (1.25–2.22)	0.001	74.4	<0.001	<0.001
		FIGO stage	I–II	1.67 (1.45–1.93)	<0.001	66.9	<0.001	<0.001
			III–IV	1.59 (0.89–2.83)	0.115	–	–
			Both	1.75 (1.34–2.28)	<0.001	86.1	<0.001
		Cutoff value	≥4.0 cm	1.66 (1.39–1.98)	<0.001	78.5	<0.001	0.062
		Cutoff value	<4.0 cm	1.76 (1.43–2.17)	<0.001	77.1	<0.001	0.062
		Study quality	High	1.48 (1.28–1.72)	<0.001	68.3	<0.001	0.053
		Study quality	Low	1.90 (1.54–2.35)	<0.001	81.3	<0.001	0.053

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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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