Abstract
Background and aimsNeutrophil to lymphocyte ratio (NLR) is an inflammatory-based marker. A systematic review and meta-analysis was performed to explore the prognostic role of NLR in patients with hepatocellular carcinoma (HCC).ResultsOverall, 598 papers were identified, of which 90 papers including 20,475 HCC patients were finally included. Low baseline NLR was significantly associated with better overall survival (HR = 1.80, 95% CI: 1.59–2.04, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.80–2.76, p < 0.00001). Low post- treatment NLR was significantly associated with better overall survival (HR = 1.90, 95% CI: 1.22–2.94, p = 0.004). Decreased NLR was significantly associated with overall survival (HR = 2.23, 95%CI: 1.83–2.72, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.83–2.72, p < 0.00001). The findings from most of subgroup meta-analyses were consistent with those from the overall meta-analyses.Materials and MethodsAll relevant literatures were identified via PubMed, EMBASE, and Cochrane library databases. Hazard ratio (HR) with 95% confidence interval (95%CI) was calculated. Subgroup meta-analyses were performed according to the treatment options, NLR cut-off value ranges, and regions.ConclusionsNLR should be a major prognostic factor for HCC patients. NLR might be further incorporated into the prognostic model of HCC.
Highlights
Prognostic assessment of hepatocellular carcinoma (HCC) is very important for clinicians and patients
Low baseline Neutrophil to lymphocyte ratio (NLR) was significantly associated with better overall survival (HR = 1.80, 95% CI: 1.59–2.04, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.80–2.76, p < 0.00001)
Low post- treatment NLR was significantly associated with better overall survival (HR = 1.90, 95% CI: 1.22–2.94, p = 0.004)
Summary
Prognostic assessment of hepatocellular carcinoma (HCC) is very important for clinicians and patients. As for the prognostic staging of HCC, the Barcelona Clinic Liver Cancer (BCLC) system is the most frequently used tool with 5 major parameters, such as tumor size, tumor number, Child-Pugh class, physical status, and tumor metastasis [2]. As for the liver function assessment of HCC, Child-Pugh class is the most frequently used tool with 5 variables, such as bilirubin, albumin, international normalized ratio, www.impactjournals.com/oncotarget ascites, and hepatic encephalopathy [6]. NLR reflects the potential balance between neutrophil-associated pro-tumor inflammation and lymphocyte-dependent anti-tumor immune function [8–11]. We have conducted a systematic review and meta-analysis to analyze the prognostic role of NLR in HCC patients treated with different treatment options. A systematic review and meta-analysis was performed to explore the prognostic role of NLR in patients with hepatocellular carcinoma (HCC)
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