Abstract
An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS).We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively.Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.
Highlights
As the genomic revolution advances, more molecular biomarkers have been discovered that can serve as druggable targets or prognosticators of therapeutic efficacy, disease recurrence, or survival
In this systematic review and meta-analysis, we identified over a decade and a half of data from 45,905 GI cancer patients that underwent neutrophil-to-lymphocyte ratio testing to determine overall survival (OS) as well as disease-free survival (DFS), progression-free survival (PFS), or cancerspecific survival (CSS). 143 studies were retrospective, with one correlation study of NLR with a phase III RCT [5]
Our meta-analysis pooled 45,905 patients to assess the prognostic indication of NLR with GI cancers reported in 144 studies of variable risk of bias
Summary
As the genomic revolution advances, more molecular biomarkers have been discovered that can serve as druggable targets or prognosticators of therapeutic efficacy, disease recurrence, or survival. Though exciting to provide these novel options for patients, the cost of employing these molecular markers and the time to send off and obtain results can be significant. Even in this day of genomic and proteomic advancements, a simple, inexpensive and readily available prognostic marker is still highly desirable. One of the simplest and most readily available tests in the clinic is the complete blood cell count (CBC), which reports the absolute neutrophil count (ANC) and absolute lymphocyte count (ALC). The neutrophil-to-lymphocyte ratio (NLR), calculated by dividing the ANC by the ALC, can serve as an index of systemic inflammatory response in critically ill patients [1]. An increasing number of recent reports suggest that NLR can be used as a prognostic marker in various malignancies
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
