Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis.
The neutrophil-to-lymphocyte ratio (NLR) is a useful biomarker that reflects systemic inflammation responses. However, the prognostic value of the NLR in patients with primary liver cancer (PLC) remains controversial. We performed a meta-analysis of 26 studies (comprising 4,461 patients) to evaluate the association between the pre-treatment NLR and clinical outcomes of overall survival (OS) and disease-free survival (DFS) in patients with PLC. The correlation between NLR and tumor characteristics or other inflammation-related parameters was also assessed. Data were synthesized using the random-effects model of DerSimonian and Laird, and the hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) was used to estimate effect size. Our analysis indicated that a high NLR predicted poor OS (HR, 2.102; 95% CI: 1.741-2.538) and DFS (HR, 2.474; 95% CI: 1.855-3.300) for PLC. A high NLR was associated with the presence of tumor vascular invasion (OR: 1.889, 95% CI: 1.487-2.400; p<0.001) and an elevated alpha-fetoprotein level (OR: 1.536; 95% CI: 1.152-2.048; p = 0.003). Thus, we conclude that a high NLR indicates a poor prognosis for patients with PLC and may also be predictive for PLC invasion and metastasis. Subgroup analysis suggested that the predictive role of NLR in cholangiocarcinoma is limited, and a further large study to confirm these findings is warranted.
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Tong-Chun
TC
Xue
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Lan
L
Zhang
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Xiao-Yin
XY
Xie
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Ning-Ling
NL
Ge
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Li-Xin
LX
Li
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China; Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
Bo-Heng
BH
Zhang
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Sheng-Long
SL
Ye
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China.
Zheng-Gang
ZG
Ren
D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D008214:Lymphocytes / Q000166:cytology*; D009361:Neoplasm Invasiveness; D009504:Neutrophils / Q000166:cytology*; D011379:Prognosis