Abstract
BackgroundThe prognostic role of inflammation indices, such as the neutrophil-to-lymphocyte ratio (NLR) in gastric cancer (GC) remains controversial. We conducted a meta-analysis to determine the predictable value of NLR in the clinical outcome of GC patients.MethodsWe searched Embase, PubMed and the Cochrane Library database for relevant randomised controlled trials. Statistical analyses were conducted to calculate the hazard ratio (HR) and 95% confidence intervals of overall survival (OS) and progression-free survival (PFS) using either random-effect or fixed-effect models according to the heterogeneity of the included studies. An analysis was carried out based on data from nine studies to evaluate the association between NLR and OS in patients with GC.ResultsOur analysis indicated that elevated pre-treatment NLR predicted poorer OS (HR: 2.16, 95% CI: 1.86 to 2.51, P < 0.001) and PFS (HR 2.78, 95% CI: 1.95 to 3.96; P < 0.00001) in patients with GC. Over a 3-year follow-up period, high NLR was a significant predictor of poor outcomes at year 1 (HR 1.99; 95% CI: 1.39 to 2.85; P = 0.0002), year 2 (HR 2.24; 95% CI: 1.69 to 2.97; P < 0.00001) and year 3 (HR 2.80; 95% CI: 1.98 to 3.96; P < 0.00001).ConclusionsElevated preoperative NLR is associated with poorer rates of survival in GC patients and may play a role in GC surveillance programmes as a means of delivering more personalised cancer care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-015-0530-9) contains supplementary material, which is available to authorized users.
Highlights
The prognostic role of inflammation indices, such as the neutrophil-to-lymphocyte ratio (NLR) in gastric cancer (GC) remains controversial
One other study was excluded because it reported the prognostic value of the inflammation index constructed by NLR and another index (c-reactive protein) but failed to present NLR-specific data
GC patients undergoing resection of the primary lesion overall survival (OS) among the six studies included in this subgroup analysis showed a significant survival disadvantage in the high’ pre-treatment NLR (HNLR) group (HR 2.10, 95% confidence interval (CI): 1.49 to 2.95, P < 0.0001)
Summary
The prognostic role of inflammation indices, such as the neutrophil-to-lymphocyte ratio (NLR) in gastric cancer (GC) remains controversial. Despite its declined incidence in recent decades, gastric cancer (GC) remains a major health problem around the world [1]. It is the fifth most common cancer worldwide, with about one million (952,000) new cases diagnosed annually, and it was the third leading cause of cancer deaths (723,000 deaths) in 2012, according to the World Health Organization’s GLOBOCAN database [2]. Despite rapid developments in surgery, chemotherapy and molecular therapy in the recent years, the clinical outcome of GC is still not promising. This is mainly due to local tumour recurrence or distal metastasis. The complex and diverse neuroendocrinological and haemopoetic changes that occur during inflammation are
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