Abstract
BackgroundThis study aimed to summarize the previously published literature on the role of platelet-to-lymphocyte ratio (PLR) on overall survival (OS) in patients with gastric cancer.MethodsWe systematically searched PubMed, EmBase, and the Cochrane library to identify eligible studies to review. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effects model. Sensitivity and subgroup analyses were performed, and publication bias was assessed.ResultsA total of 28 studies comprising 15,617 patients with gastric cancer were included in this meta-analysis. The pooled results indicated that elevated PLR was associated with poor OS (HR: 1.37; 95% CI: 1.24–1.51; P < 0.001). A significant publication bias was observed (Egger test, P = 0.036; Begg test, P = 0.017). After adjusting for publication bias using the trim and fill method, an adjusted pooled HR of 1.19 (95% CI: 1.08–1.33; P = 0.001) was observed. Subgroup analyses indicated an elevated PLR in retrospective studies. Studies conducted in Turkey, the UK, the USA, and Costa Rica; studies with a sample size of < 1000, with < 70% male patients, and with patients treated with chemotherapy; studies with PLR cutoff value of ≥200; and studies with lower quality as determined by the Newcastle-Ottawa Scale all showed greater harmful effects on OS than their corresponding subsets (P < 0.05).ConclusionsAn elevated PLR was associated with poor OS in patients with gastric cancer. These results might differ between studies due to differences in design, country of origin, sample size, sex proportion, treatment strategy, PLR cutoff value, and study quality.
Highlights
This study aimed to summarize the previously published literature on the role of platelet-to-lymphocyte ratio (PLR) on overall survival (OS) in patients with gastric cancer
Meta-analysis and sensitivity analysis After pooling all included studies, patients with gastric cancer with an elevated PLR were noted to have lower OS than those with lower PLR level (HR: 1.37; 95% confidence intervals (CIs): 1.24–1.51; P < 0.001; Fig. 2)
Studies conducted in Turkey, the UK, the USA, and Costa Rica; studies with sample size of < 1000; studies including < 70% male patients; studies with patients treated with chemotherapy; studies with PLR
Summary
This study aimed to summarize the previously published literature on the role of platelet-to-lymphocyte ratio (PLR) on overall survival (OS) in patients with gastric cancer. The standard treatment strategy for Several studies have indicated that the immune system can affect tumor growth, with neutrophils, lymphocytes, monocytes, and platelets possibly playing an important role in the tumor-induced systemic inflammatory response [6, 7]. This response may accelerate tumor development and metastasis through the following mechanisms: promoting secretion of inflammatory mediators and cytokines, inhibiting apoptosis, and damaging the tumor cell DNA [8].
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