Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors : A systematic review and meta-analysis of 66 cohort studies
A partir d'une revue systématique de la littérature publiée jusqu'en avril 2016 (66 études incluant au total 24 536 patients), cette méta-analyse évalue l'intérêt de déterminer avant traitement le rapport sérique neutrophiles/lymphocytes pour établir un pronostic chez les patients atteints d'un cancer de stade avancé
Background : Neutrophil-to-lymphycyte ratio (NLR) is crucial for the incidence and mortality of various tumors. However, little is known on NLR and its association with prognosis in advanced tumors. Here we performed a meta-analysis to establish the prognostic significance of pretreatment blood NLR for advanced tumors.
Methods : A systematic literature search through April 2016 was performed to evaluate the association between pretreatment blood NLR and overall survival (OS) or progression-free survival (PFS) in patients with advanced tumors. Data were extracted from studies reporting hazard ratios (HRs) and 95% confidence interval (CI) and pooled using the Mantel–Haenszel random-effect model.
Results : Sixty-six studies with a total of 24536 individuals were included in the meta-analysis. Pooled analyses revealed that elevated pretreatment NLR was associated with worse OS (HR 1.70, 95% CI 1.57 to 1.84, P <0.001) and PFS (HR 1.61, 95% CI 1.42 to 1.82, P <0.001) in advanced tumors. Subgroup analysis stratified by tumor type demonstrated that pancreatic cancer patients with high pretreatment NLR had the worst OS (HR 1.94, 95% CI 1.55 to 2.54, P < 0.001) and colorectal cancer with the worst PFS (HR 1.74, 95% CI 1.04 to 2.90, P < 0.001). When stratified by cut-off value for NLR, we found that cut-off value being five indicated the worst PFS (HR 2.23, 95% CI 1.54 to 3.23, P=0.019).
Conclusions : Overall, high pretreatment blood NLR could be an adverse prognostic indicator for advanced tumor. Large-scale prospective studies investigating its survival outcomes in specific cancer type are strongly advocated.
Cancer Treatment Reviews , résumé, 2016