Abstract
Objective To research the impact of neutrophil-lymphocyte ratio (NLR) as a prognostic parameter in non-small-cell lung cancer (NSCLC) patients treated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Methods We searched the databases such as the American Society of Clinical Oncology (ASCO), EMBASE, PubMed, the European Society of Medical Oncology (ESMO), Wanfang, and CNKI for articles illustrating the impact of pretreatment NLR on survival data in NSCLC patients undergoing EGFR-TKIs treatment. We did a meta-analysis for overall survival (OS) and progression-free survival (PFS). Results We recruited 10 studies in our meta-analysis. Our study suggested that patients with low NLR had better PFS (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = (1.16–2.39), and P value = 0.005) and OS (HR = 1.66, 95% CI = (1.08–2.55), and P value = 0.02) in comparison to patients with high NLR. Conclusion In conclusion, our meta-analysis revealed that lower NLR predicted a better survival (PFS and OS) in patients receiving the treatment of EGFR-TKIs.
Highlights
Journal of Oncology e previous meta-analysis revealed that neutrophil-lymphocyte ratio (NLR) predicted elevated length of survival in non-small-cell lung cancer (NSCLC) patients with systematic treatment including chemotherapy, targeted therapy, and immunotherapy [9, 10]
Literature Search. e American Society of Clinical Oncology (ASCO), EMBASE, PubMed, European Society of Medical Oncology (ESMO), Wanfang, and CNKI databases were searched by independent researchers with the following keywords: non-small cell lung cancer, lung cancer, neutrophil lymphocyte ratio, epidermal growth factor receptor tyrosine kinase inhibitors, NSCLC, NLR, EGFR-TKIs, erlotinib, gefitinib, icotinib, afatinib, osimertinib, survival, progression-free survival (PFS), and overall survival (OS)
10 clinical studies met the inclusion criteria and were included in our meta-analysis, with 9 trials about the significant relevance of NLR on PFS and 7 trials about the significant relevance of NLR on OS. e study flow diagram is illustrated in Figure 1. e study characteristics of the ten recruited articles are summarized in Table 1, including author’s name, publication year, patient source, number of patients, study design, NLR cutoff values, treatment, median PFS, median OS, and follow-up time
Summary
Journal of Oncology e previous meta-analysis revealed that NLR predicted elevated length of survival in NSCLC patients with systematic treatment including chemotherapy, targeted therapy, and immunotherapy [9, 10]. Recruiting clinical studies with different treatment methods and patients in different stages increased the heterogeneity of our study. No meta-analysis focused on the impact of NLR on prognosis in NSCLC patients receiving EGFR-TKIs. us, we decided to do a meta-analysis investigating clinical studies about pretreatment NLR level on survival in NSCLC patients with EGFR-TKIs treatment. Our hypothesis is that patients with lower NLR could be a prognostic parameter for improved length of survival in patients with NSCLC treated with EGFR-TKIs
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