Prognostic value of lymph node ratio in children with wilms tumor: a systematic review and meta-analysis

Background

Lymph node (LN) involvement is a critical determinant of staging and prognosis in Wilms tumor (WT). However, conventional binary nodal staging (positive vs. negative) is often compromised by significant variability in surgical lymph node sampling. The lymph node ratio (LNR), which integrates metastatic burden and sampling adequacy, has emerged as a potential prognostic alternative. This systematic review and meta-analysis evaluated whether LNR serves as an independent predictor of survival outcomes in children with WT.