Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies.
Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies.
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DOI：
10.1186/s12916-020-01817-1
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发表时间：
2020-11-20
期刊：
影响因子：
9.3
通讯作者：
Berlanga-Taylor AJ
中科院分区：
文献类型：
--
作者：
Cupp MA;Cariolou M;Tzoulaki I;Aune D;Evangelou E;Berlanga-Taylor AJ
虽然中性粒细胞与癌症的进展有关，但其与癌症结局的相关性存在不确定性，这取决于所考虑的部位、结局和治疗。我们的目的是评估中性粒细胞与淋巴细胞比率（NLR）或肿瘤相关中性粒细胞（TAN）与癌症预后之间相关性证据的强度和有效性。我们检索了MEDLINE、Embase和科克伦系统性综述数据库，从开始到2020年5月29日，对中性粒细胞计数（此处为NLR或TAN）和与疾病进展或生存期相关的特定癌症结局的观察性研究进行了系统性综述和荟萃分析。通过应用预先设定的GRADE标准，将现有证据分为强有力、高度提示、提示、弱有力或不确定。来自86项研究的204项荟萃分析调查了NLR或TAN与癌症结局之间的关系，符合纳入标准。除一项荟萃分析外，其他所有荟萃分析均发现风险比（HR）增加（HR > 1）。我们没有发现足够的荟萃分析来评价TAN和癌症结局（N = 9）。当评估与异质性和小研究效应相关的效应幅度、显著性和偏倚时，18例（9%）NLR与复合癌症终点（联合分析）、免疫治疗癌症和某些部位特异性癌症（泌尿系统、鼻咽、胃、乳腺、子宫内膜、软组织肉瘤和肝细胞癌）结局之间的相关性得到了强有力的证据支持。总共有60项（29%）荟萃分析提供了强有力或高度提示性的证据。尽管NLR和TAN在与癌症预后不良相关方面具有临床前景，但需要进一步研究以提供强有力的证据，评估因果关系并测试临床效用。繁荣CRD42017069131。
Although neutrophils have been linked to the progression of cancer, uncertainty exists around their association with cancer outcomes, depending on the site, outcome and treatments considered. We aimed to evaluate the strength and validity of evidence on the association between either the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis. We searched MEDLINE, Embase and Cochrane Database of Systematic Reviews from inception to 29 May 2020 for systematic reviews and meta-analyses of observational studies on neutrophil counts (here NLR or TAN) and specific cancer outcomes related to disease progression or survival. The available evidence was graded as strong, highly suggestive, suggestive, weak or uncertain through the application of pre-set GRADE criteria. A total of 204 meta-analyses from 86 studies investigating the association between either NLR or TAN and cancer outcomes met the criteria for inclusion. All but one meta-analyses found a hazard ratio (HR) which increased risk (HR > 1). We did not find sufficient meta-analyses to evaluate TAN and cancer outcomes (N = 9). When assessed for magnitude of effect, significance and bias related to heterogeneity and small study effects, 18 (9%) associations between NLR and outcomes in composite cancer endpoints (combined analysis), cancers treated with immunotherapy and some site specific cancers (urinary, nasopharyngeal, gastric, breast, endometrial, soft tissue sarcoma and hepatocellular cancers) were supported by strong evidence. In total, 60 (29%) meta-analyses presented strong or highly suggestive evidence. Although the NLR and TAN hold clinical promise in their association with poor cancer prognosis, further research is required to provide robust evidence, assess causality and test clinical utility. PROSPERO CRD42017069131.
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