Abstract
Simple SummaryPlatelet-to-lymphocyte ratio has shown prognostic value in several malignancies; however, its role in cholangiocarcinoma remains to be determined. Therefore, we conducted a systematic review and meta-analysis of the currently available literature. Overall, our analysis revealed that a high platelet-to-lymphocyte ratio before treatment is associated with an impaired long-term oncological outcome. Further, our results indicate that this assumption was not influenced by the used treatment modality (surgical vs. non-surgical), PLR cut-off values, study population age, or sample size of the included studies. Thus, an elevated pretreatment platelet-to-lymphocyte ratio has valid prognostic value for cholangiocarcinoma patients.The platelet-to-lymphocyte ratio (PLR), an inflammatory parameter, has shown prognostic value in several malignancies. The aim of this meta-analysis was to determine the impact of pretreatment PLR on the oncological outcome in patients with cholangiocarcinoma (CCA). A systematic literature search has been carried out in the PubMed and Google Scholar databases for pertinent papers published between January 2000 and August 2021. Within a random-effects model, the pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated to investigate the relationships among the PLR, overall survival (OS), and disease-free survival (DFS). Subgroup analysis, sensitivity analysis, and publication bias were also conducted to further evaluate the relationship. A total of 20 articles comprising 5429 patients were included in this meta-analysis. Overall, the pooled outcomes revealed that a high PLR before treatment is associated with impaired OS (HR = 1.14; 95% CI = 1.06–1.24; p < 0.01) and DFS (HR = 1.57; 95% CI = 1.19–2.07; p < 0.01). Subgroup analysis revealed that this association is not influenced by the treatment modality (surgical vs. non-surgical), PLR cut-off values, or sample size of the included studies. An elevated pretreatment PLR is prognostic for the OS and DFS of CCA patients. More high-quality studies are required to investigate the pathophysiological basis of the observation and the prognostic value of the PLR in clinical management as well as for patient selection.
Highlights
Cholangiocarcinoma (CCA) is the second most common primary liver tumor, accounting for 5 to 30% of all primary liver malignancies
With respect to the anatomical location, CCA can be divided into intrahepatic CCA and extrahepatic CCA, which are related to distinct pathophysiology and clinical outcomes [3,4]
The pooled outcomes revealed that a high pretreatment plateletto-lymphocyte ratio (PLR) is associated with impaired overall survival (OS) (HR = 1.14, 95% confidence interval (CI) = 1.06–1.24, p < 0.01) and reduced disease-free survival (DFS) (HR = 1.57, 95% CI = 1.19–2.07, p < 0.01)
Summary
Cholangiocarcinoma (CCA) is the second most common primary liver tumor, accounting for 5 to 30% of all primary liver malignancies. The inflammatory response of the host in the tumor microenvironment is known to play a crucial role in cancer growth and progression and is further linked to systemic inflammation [5] In this context, counts of neutrophils, lymphocytes, and platelets, as well as hypoalbuminemia and high C-reactive protein (CRP) levels have all been used to calculate clinical scores or ratios, such as the Glasgow Prognostic Score (GPS), the plateletto-lymphocyte ratio (PLR), and the neutrophil-to-lymphocyte ratio (NLR), which have shown associations with oncological and surgical outcomes in various solid tumors [6,7,8,9]. As low lymphocyte counts may be associated with shorter oncological survival, the ratio of platelet to lymphocyte (PLR) has been proposed as a prognostic biomarker [17,18] The aim of this systemic review and meta-analysis was, to elucidate the role of PLR in oncological outcomes in CCA
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