Neutrophil–lymphocyte ratio and CEA level as prognostic and predictive factors in colorectal cancer: A systematic review and meta-analysis

Inflammation plays a major role in cancer development and progression and has the potential to be used as a prognostic marker in cancer. Previous studies have attempted to evaluate Platelet-to-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) as indicators of inflammation/prognostic markers in cancer, but there is no common consensus on their application in clinical practice. The aim of this systematic review and meta-analysis is to (a) assess the prognostic efficacy of all three prognostic markers in comparison to each other and (b) investigate the prognostic potential of these three markers in HNC. The study followed PRISMA guidelines, with the literature being collated from multiple bibliographic databases. Preliminary and secondary screening were carried out using stringent inclusion/exclusion criteria. Meta-analysis was carried out on selected studies using CMA software and HR as the pooled effect size metric. A total of 49 studies were included in the study. The pooled HR values of PLR, NLR and MLR indicated that they were significantly correlated with poorer OS. The pooled effect estimates for PLR, NLR and MLR were 1.461 (95% CI 1.329–1.674), 1.639 (95% CI 1.429–1.880) and 1.002 (95% CI 0.720–1.396), respectively. Significant between-study heterogeneity was observed in the meta-analysis of all three. The results of this study suggest that PLR, NLR and MLR ratios can be powerful prognostic markers in head and neck cancers that can guide treatment. Further evidence from large-scale clinical studies on patient cohorts are required before they can be incorporated as a part of the clinical method. PROSPERO Registration ID: CRD42019121008

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The prognostic significance of preoperative neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma receiving hepatectomy: A systematic review and meta-analysis

International Journal of Surgery ◽

10.1016/j.ijsu.2018.05.022 ◽

2018 ◽

Vol 55 ◽

pp. 73-80 ◽

Cited By ~ 28

Author(s):

Yunjiao Wang ◽

Chuchu Peng ◽

Zhigang Cheng ◽

Ximei Wang ◽

Lei Wu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Meta Analysis ◽

Prognostic Significance ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

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Neutrophil-lymphocyte ratio predicts the outcome of intracerebral hemorrhage: A meta-analysis and systematic review v1 (protocols.io.qzwdx7e)

protocols.io ◽

10.17504/protocols.io.qzwdx7e ◽

2018 ◽

Author(s):

weiduan zhuang

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

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The pretransplant neutrophil-lymphocyte ratio as a new prognostic predictor after liver transplantation for hepatocellular cancer: a systematic review and meta-analysis

Biomarkers in Medicine ◽

10.2217/bmm-2017-0307 ◽

2018 ◽

Vol 12 (2) ◽

pp. 189-199 ◽

Cited By ~ 15

Author(s):

Zheng-Guang Xu ◽

Cheng-Jie Ye ◽

Lin-Xun Liu ◽

Gang Wu ◽

Zhan-Xue Zhao ◽

...

Keyword(s):

Systematic Review ◽

Liver Transplantation ◽

Meta Analysis ◽

Hepatocellular Cancer ◽

Prognostic Predictor ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

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Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers11040530 ◽

2019 ◽

Vol 11 (4) ◽

pp. 530 ◽

Cited By ~ 5

Author(s):

van den Ende ◽

ter Veer ◽

Mali ◽

van Berge Henegouwen ◽

Hulshof ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Esophageal Cancer ◽

Prognostic Factors ◽

Predictive Factors ◽

Meta Analysis ◽

Curative Treatment ◽

Controlled Trials ◽

Randomized Controlled ◽

Prognostic And Predictive Factors

Background: An overview of promising prognostic variables and predictive subgroups concerning the curative treatment of esophageal and gastric cancer from randomized controlled trials (RCTs) is lacking. Therefore, we conducted a systematic review and meta-analysis. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to March 2019 for RCTs on the curative treatment of esophageal or gastric cancer with data on prognostic and/or predictive factors for overall survival. Prognostic factors were deemed potentially clinically relevant according to the following criteria; (1) statistically significant (p < 0.05) in a multivariate analysis, (2) reported in at least 250 patients, and (3) p < 0.05, in ≥ 33% of the total number of patients in RCTs reporting this factor. Predictive factors were potentially clinically-relevant if (1) the p-value for interaction between subgroups was <0.20 and (2) the hazard ratio in one of the subgroups was significant (p < 0.05). Results: For gastric cancer, 39 RCTs were identified (n = 13,530 patients) and, for esophageal cancer, 33 RCTs were identified (n = 8618 patients). In total, we identified 23 potentially clinically relevant prognostic factors for gastric cancer and 16 for esophageal cancer. There were 15 potentially clinically relevant predictive factors for gastric cancer and 10 for esophageal cancer. Conclusion: The identified prognostic and predictive factors can be included and analyzed in future RCTs and be of guidance for nomograms. Further validation should be performed in large patient cohorts.

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Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420951315 ◽

2020 ◽

Vol 54 (8) ◽

pp. 697-706

Author(s):

Sarah M. Jackson ◽

Luke A. Perry ◽

Carla Borg ◽

Dhruvesh M. Ramson ◽

Ryan Campbell ◽

...

Keyword(s):

Systematic Review ◽

Risk Stratification ◽

Vascular Surgery ◽

Vascular Disease ◽

Meta Analysis ◽

Narrative Review ◽

Cochrane Library ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Chi Squared

Objective: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. Methods: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. Results: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. Conclusions: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.

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