Prognostic Utility of Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis.

Chellan Kumarasamy,Deepa Suresh,Vaibhav Tiwary,Krishnan Sunil,Siddhartha Baxi,Sameep Shetty,Rama Jayaraj,Gothandam Kodiveri Muthukaliannan

doi:10.3390/cancers13164166

Abstract

Simple SummaryInflammation plays a major role in cancer development and progression and has the potential to be used as a prognostic marker in cancer. Previous studies have attempted to evaluate PLR, NLR and MLR as indicators of inflammation/prognostic markers in cancer, but there is no common consensus on its application in clinical practice. The aim of this systematic review and meta-analysis (a) assess the prognostic efficacy of all three prognostic markers in comparison to each other and, (b) investigate the prognostic potential of these three markers in HNC. The study followed PRISMA guidelines, with literature being collated from multiple bibliographic databases. Preliminary and secondary screening were carried out using stringent inclusion/exclusion criteria.Inflammation plays a major role in cancer development and progression and has the potential to be used as a prognostic marker in cancer. Previous studies have attempted to evaluate Platelet-to-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) or monocyte–lymphocyte ratio (MLR) as indicators of inflammation/prognostic markers in cancer, but there is no common consensus on their application in clinical practice. The aim of this systematic review and meta-analysis is to (a) assess the prognostic efficacy of all three prognostic markers in comparison to each other and (b) investigate the prognostic potential of these three markers in HNC. The study followed PRISMA guidelines, with the literature being collated from multiple bibliographic databases. Preliminary and secondary screening were carried out using stringent inclusion/exclusion criteria. Meta-analysis was carried out on selected studies using CMA software and HR as the pooled effect size metric. A total of 49 studies were included in the study. The pooled HR values of PLR, NLR and MLR indicated that they were significantly correlated with poorer OS. The pooled effect estimates for PLR, NLR and MLR were 1.461 (95% CI 1.329–1.674), 1.639 (95% CI 1.429–1.880) and 1.002 (95% CI 0.720–1.396), respectively. Significant between-study heterogeneity was observed in the meta-analysis of all three. The results of this study suggest that PLR, NLR and MLR ratios can be powerful prognostic markers in head and neck cancers that can guide treatment. Further evidence from large-scale clinical studies on patient cohorts are required before they can be incorporated as a part of the clinical method. PROSPERO Registration ID: CRD42019121008

Highlights

It is an established fact that cancer pathophysiology relies heavily on the manipulation of the immune system involved in cancer cell growth, proliferation and tumorigenesis [1].Immunological involvement, or, inflammation, has been defined as one of the hallmarks of cancer and plays a role in malignancy, angiogenesis and genomic instability [2]
The ease of accessibility, low cost and patient comfort associated with this analysis provide significant benefits if Platelet-to-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and monocyte–lymphocyte ratio (MLR) are established as clinically reliable cancer prognosticators
This is especially useful in a tumor such as head and neck cancers (HNC), especially human papilloma virus (HPV)-negative HNC, because there is currently no universally approved non-invasive and affordable biomarker that serves as a surrogate for tumor burden or treatment response

Summary

Introduction

Immunological involvement, or, inflammation, has been defined as one of the hallmarks of cancer and plays a role in malignancy, angiogenesis and genomic instability [2]. An assessment of the magnitude of inflammation in cancer patients could be used to determine disease prognosis. Monocytes have a key role in inflammation, as seen in their presence in atherosclerosis [8]. The systemic inflammatory response elicited by the immune cells seen in cancer is interconnected with the nutritional depletion seen in cancer patients and affects the prognosis and course of the disease independently of tumor stage [10]. Lymphocytes represent one third of the total white blood cells, play a significant role in cellular immunity and may stimulate the clearance of malignant cells [11]. An assessment of the MLR at different stages pretreatment or post-treatment can help in anticipating the prognosis of the disease and improving treatment decisions [13]

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