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Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis.

Xue TC, Zhang L, Xie XY, Ge NL, Li LX, Zhang BH, Ye SL, Ren ZG - PLoS ONE (2014)

Bottom Line: Data were synthesized using the random-effects model of DerSimonian and Laird, and the hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) was used to estimate effect size.Thus, we conclude that a high NLR indicates a poor prognosis for patients with PLC and may also be predictive for PLC invasion and metastasis.Subgroup analysis suggested that the predictive role of NLR in cholangiocarcinoma is limited, and a further large study to confirm these findings is warranted.

View Article: PubMed Central - PubMed

Affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.

ABSTRACT
The neutrophil-to-lymphocyte ratio (NLR) is a useful biomarker that reflects systemic inflammation responses. However, the prognostic value of the NLR in patients with primary liver cancer (PLC) remains controversial. We performed a meta-analysis of 26 studies (comprising 4,461 patients) to evaluate the association between the pre-treatment NLR and clinical outcomes of overall survival (OS) and disease-free survival (DFS) in patients with PLC. The correlation between NLR and tumor characteristics or other inflammation-related parameters was also assessed. Data were synthesized using the random-effects model of DerSimonian and Laird, and the hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) was used to estimate effect size. Our analysis indicated that a high NLR predicted poor OS (HR, 2.102; 95% CI: 1.741-2.538) and DFS (HR, 2.474; 95% CI: 1.855-3.300) for PLC. A high NLR was associated with the presence of tumor vascular invasion (OR: 1.889, 95% CI: 1.487-2.400; p<0.001) and an elevated alpha-fetoprotein level (OR: 1.536; 95% CI: 1.152-2.048; p = 0.003). Thus, we conclude that a high NLR indicates a poor prognosis for patients with PLC and may also be predictive for PLC invasion and metastasis. Subgroup analysis suggested that the predictive role of NLR in cholangiocarcinoma is limited, and a further large study to confirm these findings is warranted.

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Stratified forest plots of the association between the NLR and OS.(A) Subgroup analysis in patients who received different treatments. (B) Subgroup analysis in studies with an NLR cut-off value less than or greater than 5. (C) Subgroup analysis was based on the region in which the study was reported, including 13 Eastern studies and 8 Western studies. Green represents the subgroup pooled effective size, whereas red represents the overall pooled effective size. NLR  =  neutrophil-to-lymphocyte ratio; OS  =  overall survival; CI  =  confidence interval; TL  =  transplantation; *, the different study by Pinato.
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pone-0096072-g003: Stratified forest plots of the association between the NLR and OS.(A) Subgroup analysis in patients who received different treatments. (B) Subgroup analysis in studies with an NLR cut-off value less than or greater than 5. (C) Subgroup analysis was based on the region in which the study was reported, including 13 Eastern studies and 8 Western studies. Green represents the subgroup pooled effective size, whereas red represents the overall pooled effective size. NLR  =  neutrophil-to-lymphocyte ratio; OS  =  overall survival; CI  =  confidence interval; TL  =  transplantation; *, the different study by Pinato.

Mentions: We further explored potential causes of the heterogeneity in the meta-analysis. First, we analyzed the significance of a high NLR with respect to the OS for patients who received different treatments. Among six resection studies, two RFA studies, five TACE studies, and five liver transplantation studies, the prognostic role of the NLR in OS was favored in most studies and the pooled estimate of the NLR was significant (HR, 1.679; 95% CI: 1.529, 1.843; p<0.001) (Fig. 3A). Statistical heterogeneity was found in the subgroups that received multiple treatments (I-squared = 90.72%; p<0.001) and resection (I-squared = 49.4%, p = 0.078); heterogeneity was not found in the subgroups that received RFA (I-squared = 0.0%; p = 0.322), TACE (I-squared = 6.97%, p = 0.367), or transplantation (I-squared = 0.0%; p = 0.487).


Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis.

Xue TC, Zhang L, Xie XY, Ge NL, Li LX, Zhang BH, Ye SL, Ren ZG - PLoS ONE (2014)

Stratified forest plots of the association between the NLR and OS.(A) Subgroup analysis in patients who received different treatments. (B) Subgroup analysis in studies with an NLR cut-off value less than or greater than 5. (C) Subgroup analysis was based on the region in which the study was reported, including 13 Eastern studies and 8 Western studies. Green represents the subgroup pooled effective size, whereas red represents the overall pooled effective size. NLR  =  neutrophil-to-lymphocyte ratio; OS  =  overall survival; CI  =  confidence interval; TL  =  transplantation; *, the different study by Pinato.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008563&req=5

pone-0096072-g003: Stratified forest plots of the association between the NLR and OS.(A) Subgroup analysis in patients who received different treatments. (B) Subgroup analysis in studies with an NLR cut-off value less than or greater than 5. (C) Subgroup analysis was based on the region in which the study was reported, including 13 Eastern studies and 8 Western studies. Green represents the subgroup pooled effective size, whereas red represents the overall pooled effective size. NLR  =  neutrophil-to-lymphocyte ratio; OS  =  overall survival; CI  =  confidence interval; TL  =  transplantation; *, the different study by Pinato.
Mentions: We further explored potential causes of the heterogeneity in the meta-analysis. First, we analyzed the significance of a high NLR with respect to the OS for patients who received different treatments. Among six resection studies, two RFA studies, five TACE studies, and five liver transplantation studies, the prognostic role of the NLR in OS was favored in most studies and the pooled estimate of the NLR was significant (HR, 1.679; 95% CI: 1.529, 1.843; p<0.001) (Fig. 3A). Statistical heterogeneity was found in the subgroups that received multiple treatments (I-squared = 90.72%; p<0.001) and resection (I-squared = 49.4%, p = 0.078); heterogeneity was not found in the subgroups that received RFA (I-squared = 0.0%; p = 0.322), TACE (I-squared = 6.97%, p = 0.367), or transplantation (I-squared = 0.0%; p = 0.487).

Bottom Line: Data were synthesized using the random-effects model of DerSimonian and Laird, and the hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) was used to estimate effect size.Thus, we conclude that a high NLR indicates a poor prognosis for patients with PLC and may also be predictive for PLC invasion and metastasis.Subgroup analysis suggested that the predictive role of NLR in cholangiocarcinoma is limited, and a further large study to confirm these findings is warranted.

View Article: PubMed Central - PubMed

Affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.

ABSTRACT
The neutrophil-to-lymphocyte ratio (NLR) is a useful biomarker that reflects systemic inflammation responses. However, the prognostic value of the NLR in patients with primary liver cancer (PLC) remains controversial. We performed a meta-analysis of 26 studies (comprising 4,461 patients) to evaluate the association between the pre-treatment NLR and clinical outcomes of overall survival (OS) and disease-free survival (DFS) in patients with PLC. The correlation between NLR and tumor characteristics or other inflammation-related parameters was also assessed. Data were synthesized using the random-effects model of DerSimonian and Laird, and the hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) was used to estimate effect size. Our analysis indicated that a high NLR predicted poor OS (HR, 2.102; 95% CI: 1.741-2.538) and DFS (HR, 2.474; 95% CI: 1.855-3.300) for PLC. A high NLR was associated with the presence of tumor vascular invasion (OR: 1.889, 95% CI: 1.487-2.400; p<0.001) and an elevated alpha-fetoprotein level (OR: 1.536; 95% CI: 1.152-2.048; p = 0.003). Thus, we conclude that a high NLR indicates a poor prognosis for patients with PLC and may also be predictive for PLC invasion and metastasis. Subgroup analysis suggested that the predictive role of NLR in cholangiocarcinoma is limited, and a further large study to confirm these findings is warranted.

Show MeSH
Related in: MedlinePlus