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Prognostic role of platelet – lymphocyte ratio in colorectal cancer

View Article: PubMed Central - PubMed

ABSTRACT

Many studies have been reported that platelet–lymphocyte ratio (PLR) may be associated with the prognosis of colorectal cancer (CRC), but the results are inconsistent. Current opinion on the prognostic role of the PLR in CRC is inconsistent and inconclusive. Therefore, we conduct a meta-analysis that combines these studies and to identify the prognostic value of PLR in patients with CRC. Data were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science databases that came from inception through January 2016. We extracted data from the characteristics of each study and analyzed the relationship between PLR and overall survival (OS), disease-free survival (DFS), or other prognosis in patients with CRC by using the hazard ratio (HR) and 95% confidence intervals (95% CIs). Of the 256 identified studies, 15 studies were included and a total of 3991 patients were included. In a meta-analysis, patients with an elevated PLR had a significantly lower OS (pooled HR, 1.53; 95% CI, 1.24–1.89; P ≤ 0.001), DFS (pooled HR, 1.68; 95% CI, 1.07–2.62; P = 0.023). Even after sensitivity analyses and trim and fill method, high PLR remains significantly predictive poorer OS, but not DFS. In addition, our meta-analysis indicated that increased PLR is also significantly associated with the poor tumor differentiation [odds ratio (OR) 2.12; 95% CI, 1.45–3.08, P < 0.001)], the propensity toward depth of infiltration (OR 1.69; 95% CI, 1.20–2.39, P = 0.003), and recurrence in patients with CRC (HR, 2.71; 95% CI, 1.31–5.60, P = 0.005). This meta-analysis suggested that a high peripheral blood PLR can be used as a predictor of OS connected with clinicopathological parameters in patients with CRC, not DFS. These ratios may thus contribute to inform more personalized treatment decisions and predict treatment outcomes.

No MeSH data available.


Funnel plot adjusted using a trim and fill method for (A) OS, and (B) for DFS. Diamonds: Included studies; diamonds in squares: Presumed missing studies.
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Figure 4: Funnel plot adjusted using a trim and fill method for (A) OS, and (B) for DFS. Diamonds: Included studies; diamonds in squares: Presumed missing studies.

Mentions: There was publication bias in OS (P = 0.013) and DFS (P = 0.025) among these included studies as inferred through the visual inspection of the Begg funnel plot or Egger plot. Therefore, we needed to use a trim and fill method to estimate the asymmetry in the funnel plot. With filled unpublished studies, the recalculated pooled HRs of OS did not significantly alter by filling 5 unpublished studies (HR, 1.39; 95% CI, 1.14–1.69; P = 0.008; Fig. 4A). However, the pooled HRs did not show the correlation between PLR and DFS (HR, 1.40; 95% CI, 0.95–2.01; P < 0.001; Fig. 4B).


Prognostic role of platelet – lymphocyte ratio in colorectal cancer
Funnel plot adjusted using a trim and fill method for (A) OS, and (B) for DFS. Diamonds: Included studies; diamonds in squares: Presumed missing studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998446&req=5

Figure 4: Funnel plot adjusted using a trim and fill method for (A) OS, and (B) for DFS. Diamonds: Included studies; diamonds in squares: Presumed missing studies.
Mentions: There was publication bias in OS (P = 0.013) and DFS (P = 0.025) among these included studies as inferred through the visual inspection of the Begg funnel plot or Egger plot. Therefore, we needed to use a trim and fill method to estimate the asymmetry in the funnel plot. With filled unpublished studies, the recalculated pooled HRs of OS did not significantly alter by filling 5 unpublished studies (HR, 1.39; 95% CI, 1.14–1.69; P = 0.008; Fig. 4A). However, the pooled HRs did not show the correlation between PLR and DFS (HR, 1.40; 95% CI, 0.95–2.01; P < 0.001; Fig. 4B).

View Article: PubMed Central - PubMed

ABSTRACT

Many studies have been reported that platelet&ndash;lymphocyte ratio (PLR) may be associated with the prognosis of colorectal cancer (CRC), but the results are inconsistent. Current opinion on the prognostic role of the PLR in CRC is inconsistent and inconclusive. Therefore, we conduct a meta-analysis that combines these studies and to identify the prognostic value of PLR in patients with CRC. Data were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science databases that came from inception through January 2016. We extracted data from the characteristics of each study and analyzed the relationship between PLR and overall survival (OS), disease-free survival (DFS), or other prognosis in patients with CRC by using the hazard ratio (HR) and 95% confidence intervals (95% CIs). Of the 256 identified studies, 15 studies were included and a total of 3991 patients were included. In a meta-analysis, patients with an elevated PLR had a significantly lower OS (pooled HR, 1.53; 95% CI, 1.24&ndash;1.89; P&#8202;&le;&#8202;0.001), DFS (pooled HR, 1.68; 95% CI, 1.07&ndash;2.62; P = 0.023). Even after sensitivity analyses and trim and fill method, high PLR remains significantly predictive poorer OS, but not DFS. In addition, our meta-analysis indicated that increased PLR is also significantly associated with the poor tumor differentiation [odds ratio (OR) 2.12; 95% CI, 1.45&ndash;3.08, P&#8202;&lt;&#8202;0.001)], the propensity toward depth of infiltration (OR 1.69; 95% CI, 1.20&ndash;2.39, P = 0.003), and recurrence in patients with CRC (HR, 2.71; 95% CI, 1.31&ndash;5.60, P = 0.005). This meta-analysis suggested that a high peripheral blood PLR can be used as a predictor of OS connected with clinicopathological parameters in patients with CRC, not DFS. These ratios may thus contribute to inform more personalized treatment decisions and predict treatment outcomes.

No MeSH data available.