As implicações prognósticas dos macrófagos associados aos tumores no câncer de ovário: revisão sistemática e metanálise

Abstract

ABSTRACT Introduction: Tumor-associated macrophages (TAMs) are recognized as key prognostic factors and have been implicated in the invasion and migration of multiple cancer types. However, their impact on clinical outcomes in ovarian cancer remains incompletely understood. Methodology: This meta-analysis included 18 studies encompassing a total of 4,912 patients with ovarian cancer. The associations between TAMs and overall survival (OS), progression-free survival (PFS), and clinicopathological characteristics were evaluated. Pooled hazard ratios (HRs) were calculated for survival outcomes, and associations with clinicopathological features were also analyzed. Depending on the degree of heterogeneity, either fixed-effect or random-effects models were applied. All statistical tests were two-sided. Results: An initial search identified 1,355 records, of which 1,081 remained after duplicate removal. Following title and abstract screening, 19 articles were considered eligible for full-text review. After full-text assessment, 14 studies met the inclusion criteria. An additional ancestry search of relevant meta-analyses identified one pertinent review, from which four further eligible studies were retrieved. In total, 18 studies were included in the final analysis, comprising 4,912 patients. Across all analyses, no significant associations were observed between TAM subtypes and OS. For PFS, M2/M2-like TAMs showed a significant association under the fixed-effect model only. No consistent associations were observed for macrophage polarization ratios. Discussion: This meta-analysis suggests that M2-like TAMs may be associated with poorer progression-free survival in ovarian cancer, supporting their potential role in tumor progression and immunosuppression. However, substantial heterogeneity and inconsistent findings across studies limit the robustness of the evidence. The prognostic value of TAMs appears to depend more on macrophage polarization dynamics than on isolated biomarkers. Conclusion: Further studies using standardized macrophage markers and methodologies are needed to clarify the prognostic significance of TAMs in ovarian cancer.