Abstract
Cancer remains a leading causes of death worldwide and an elevated systemic inflammatory response (SIR) is associated with reduced survival in patients with operable cancer. This review aims to examine the evidence for the role of systemic inflammation based prognostic scores in patients with operable cancers. A wide-ranging literature review using targeted medical subject headings for human studies in English was carried out in the MEDLINE, EMBASE, and CDSR databases until the end of 2016. The SIR has independent prognostic value, across tumour types and geographical locations. In particular neutrophil lymphocyte ratio (NLR) (n = 158), platelet lymphocyte ratio (PLR) (n = 68), lymphocyte monocyte ratio (LMR) (n = 21) and Glasgow Prognostic Score/ modified Glasgow Prognostic Score (GPS/mGPS) (n = 60) were consistently validated. On meta-analysis there was a significant relationship between elevated NLR and overall survival (OS) (p < 0.00001)/ cancer specific survival (CSS) (p < 0.00001), between elevated LMR and OS (p < 0.00001)/CSS (p < 0.00001), and elevated PLR and OS (p < 0.00001)/CSS (p = 0.005). There was also a significant relationship between elevated GPS/mGPS and OS (p < 0.00001)/CSS (p < 0.00001). These results consolidate the prognostic value of the NLR, PLR, LMR and GPS/mGPS in patients with resectable cancers. This is particularly true for the NLR/GPS/mGPS which should form part of the routine preoperative and postoperative workup.
Highlights
Cancer remains one of the leading causes of mortality worldwide and is responsible for 8.8 million deaths per year1
A further 351 articles were excluded if progression free survival (PFS) was the only outcome measured (n = 112), if the treatment regime was chemotherapy/radiotherapy only (n = 58) and if survival was not expressed as hazard ratios (HR)/odds ratio (OR)/relative risk (RR)
The remaining 213 articles, had their bibliographies reviewed in a systematic manner and this identified a further 31 articles to be included in the final analysis leading to final figure of 244 articles considered in the present systematic review and meta-analysis
Summary
Cancer remains one of the leading causes of mortality worldwide and is responsible for 8.8 million deaths per year. The majority of studies used singular markers of the inflammatory response such as CRP, albumin neutrophil, lymphocyte and platelet counts, just 18 studies reported combined prognostic scores to improve prediction of survival. The majority of studies used singular markers of the inflammatory response such as CRP, albumin neutrophil, lymphocyte and platelet counts, just 18 studies reported combined prognostic scores to improve prediction of survival2 These included eight that reported the prognostic value of the GPS, and nine studies that reported the prognostic value of NLR. The majority reported have principally been ratios of components of the white cell count such as the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR) and acute phase proteins such as C-reactive protein/albumin ratio (CAR) Another approach is to combine scores of the acute phase proteins such as GPS/mGPS3,8,9. This will rationalise the evidence for the role of systemic inflammation based prognostic scores in patients with primary operable cancers
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