Abstract
BackgroundInflammation scores based on general inflammation markers as leucocyte count or C-reactive protein have been evaluated as prognostic markers of inferior survival in several cancers. In small cell lung cancer (SCLC), however, inflammation scores are less studied. In the present study, we set out to perform a systematic review and meta-analysis investigating reported associations between inflammation scores and overall survival (OS) in SCLC.MethodsA literature search was performed in PubMed, Embase, Scopus, and Web of Science following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Of the identified publications, only studies in English containing original data evaluating inflammation scores as a prognostic factor in SCLC patients were included. Hazard ratios (HRs) for OS were pooled in a random-effects model.ResultsIn total, 33 articles were included evaluating eight different inflammation scores in 7762 SCLC patients. Seven of the identified scores were based on leucocyte count. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio were the most frequently evaluated scores (NLR: n = 23; PLR: n = 22). For NLR, a meta-analysis including 16 studies demonstrated that patients with a high NLR had a significantly shorter OS compared to patients with a low NLR (pooled HR = 1.39 (95% CI, 1.23–1.56)). For PLR, an association with survival could not be confirmed in a meta-analysis performed based on eight studies (pooled HR = 1.20 (95% CI, 0.96–1.51)).ConclusionsThis review identifies that inflammation scores based on general inflammation markers have some potential as prognostic biomarkers in SCLC. The meta-analyses indicated that NLR is associated with inferior OS, whereas an association between PLR and OS could not be confirmed. Thus, NLR could be a useful biomarker of OS in SCLC patients.Systematic review registrationThe protocol for the study was submitted to the PROSPERO database (registration number CRD42020188553).
Highlights
Inflammation scores based on general inflammation markers as leucocyte count or C-reactive protein have been evaluated as prognostic markers of inferior survival in several cancers
Systematic review registration: The protocol for the study was submitted to the PROSPERO database
Study selection A total of 5563 publications were identified through searching the online databases; 2570 of these were excluded due to duplication
Summary
Inflammation scores based on general inflammation markers as leucocyte count or C-reactive protein have been evaluated as prognostic markers of inferior survival in several cancers. In small cell lung cancer (SCLC), inflammation scores are less studied. Due to the nature of the disease, the majority of patients have metastatic disease at time of diagnosis leading to poor overall survival (OS) [3]. Improvements in cancer treatment have led to improved survival in non-small cell lung cancer (NSCLC) [4], but in SCLC patients, this impact on OS has been absent until lately, where the introduction of immunotherapy has shown promising results in clinical trials for this patient group [5, 6]. To make improvements in the treatment of SCLC patients, we need prognostic markers that can identify patients who are at high risk of an inferior survival. Patients can be stratified into optimal treatment regimens or follow-up programmes which hopefully will lead to improved patient survival
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