Pretreatment hematologic markers as prognostic predictors of gastroenteropancreatic neuroendocrine tumors: a systematic review and meta-analysis.
Pretreatment hematologic markers as prognostic predictors of gastroenteropancreatic neuroendocrine tumors: a systematic review and meta-analysis.
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治疗前血液学标志物作为胃肠胰神经内分泌肿瘤的预后预测因子：系统评价和荟萃分析
DOI：
10.2147/ott.s152657
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发表时间：
2018
影响因子：
4
通讯作者：
Hou B
中科院分区：
文献类型：
--
作者：
Zhou Y;Li D;Lin Y;Yu M;Lu X;Jian Z;Na N;Hou B
外周血液学指标及淋巴细胞计数、中性粒细胞计数、血小板计数、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞比(PLR)等综合指标可反映全身炎症反应。本文对胃肠胰脏神经内分泌肿瘤(GEP-Nets)的血液学指标与预后的关系进行系统综述和荟萃分析。截至2016年8月，对PubMed、Embase和Web of Science进行了计算机化的系统搜索。检索到评估GEP-Net患者血液学参数预后价值的研究。对于Meta分析，使用Review Manager软件提取和合成了具有95%可信区间(95%CI)的风险比(HR)。我们确定了8项回顾性队列研究，共724例。大多数纳入的研究集中在胰腺神经内分泌肿瘤(PNETs)。NLR、PLR和血小板计数的预后价值分别在6项研究、2项研究和1项研究中报道。所有这些参数都与GEP-Net患者的预后相关。高NLR值与GEP-NETs预后不良显著相关(合并HR3.05，95%CI1.96~4.76，I2=0%，P<；0.00001；合并HR3.30，95%CI2.04~5.32，I2=0%，P<；0.00001)。在PNET中，低NLR在OS(合并HR4.21，95%CI1.95~9.13，I2=0%，P=0.0003)和RFS(合并HR5.37，95%CI2.14~13.47，I2=0%，P=0.003)上也有显著优势。这些发现提示NLR升高可能是GEP-Net的不良预后因素。结论应主要限于PNETs，因为纳入的大多数病例是PNET患者。其他血液学指标的预后价值值得进一步研究。我们建议进一步的研究应该使用连续的NLR变量，并采用前瞻性和配对研究设计。
Systemic inflammation can be reflected by peripheral hematologic parameters and combined index like the lymphocyte count, neutrophil count, platelet count, neutrophil-to-lymphocyte (NLR), and platelet-to-lymphocyte ratio (PLR). This systematic review and meta-analysis aimed to summarize the association between the hematologic markers and prognosis of gastroenteropancreatic neuroendocrine tumors (GEP–NETs). A computerized systematic search of PubMed, Embase, and Web of Science was conducted up to August 2016. Studies evaluating prognosis value of hematologic parameters in patients with GEP–NETs were retrieved. For meta-analysis, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were extracted and synthesized using Review Manager software. We identified eight retrospective cohort studies comprising a total of 724 cases. The majority of included studies focused on pancreatic neuroendocrine tumors (PNETs). The prognostic values of NLR, PLR, and platelet count were reported in six studies, two studies, and one study, respectively. All the parameters were associated with prognostic outcomes in patients with GEP–NETs. A high NLR was significantly associated with poor prognosis in GEP–NETs (pooled HR 3.05, 95% CI 1.96–4.76, I2 = 0%, P < 0.00001 for overall survival (OS); pooled HR 3.30, 95% CI 2.04–5.32, I2 = 0%, P < 0.00001 for recurrence-free survival [RFS]). In PNETs, pooled-analyses also showed significant superiority of a low NLR on OS (pooled HR 4.21, 95% CI 1.95–9.13, I2 = 0%, P = 0.0003) and RFS (pooled HR 5.37, 95% CI 2.14–13.47, I2 = 0%, P = 0.003). These findings suggest that the elevated NLR could be an adverse prognosis factor for GEP–NETs. The conclusion should be mainly limited to PNETs as the majority of included cases were PNET patients. The prognostic value of other hematologic parameters deserves further investigation. We recommend that further studies should use a continuous NLR variable and adopt a prospective and matched study design.