Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis.
Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis.
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DOI：
10.18632/oncotarget.16291
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发表时间：
2017-05-09
期刊：
影响因子：
--
通讯作者：
Khong HT
中科院分区：
文献类型：
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作者：
Bowen RC;Little NAB;Harmer JR;Ma J;Mirabelli LG;Roller KD;Breivik AM;Signor E;Miller AB;Khong HT
需要一种准确、省时且廉价的预后指标来降低成本并协助癌症管理的临床决策。嗜中性粒细胞与淋巴细胞比率（NLR），这是来自常见的血清测试，已在各种癌症中进行了探索。我们试图确定其在胃肠道癌症中的预后价值，并使用流行病学观察性研究的荟萃分析指南对已发表的研究进行荟萃分析。纳入了分析胃肠道癌患者的随机对照试验和观察性研究，包括NLR和总生存期（OS）、无病生存期（DFS）、无进展生存期（PFS）和/或癌症特异性生存期（CSS）的风险比（HR）。我们分析了144项研究，包括45，905名患者，其中三分之二是在2014年之后发表的。来自多变量模型的NLR报告OS的平均值、中位数和模式截止值分别为3.4、3.0、5.0（±IQR 2.5-5.0）。总体而言，NLR大于临界值与OS的HR为1.63相关（95%CI，1.53-1.73; P < 0.001）。在基于肿瘤部位、分期和地理区域的所有亚组中均观察到这种相关性。DFS、PFS和CSS的NLR升高的HR分别为1.70（95% CI，1.52-1.91，P < 0.001）、1.64（95% CI，1.36-1.97，P < 0.001）和1.83（95% CI，1.50-2.23，P < 0.001）。现有证据表明，NLR大于临界值会降低OS，与地理位置、胃肠道癌症类型或癌症分期无关。此外，DFS、PFS和CSS的结局也更差，NLR升高。
An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS). We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively. Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.