title: Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis.
abstract: BACKGROUND
  Inflammation may play an important role in cancer progression, and a high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a poor prognostic indicator in several malignancies. Here we quantify the prognostic impact of this biomarker and assess its consistency in solid tumors.
  
  
  METHODS
  A systematic review of electronic databases was conducted to identify publications exploring the association of blood NLR and clinical outcome in solid tumors. Overall survival (OS) was the primary outcome, and cancer-specific survival (CSS), progression-free survival (PFS), and disease-free survival (DFS) were secondary outcomes. Data from studies reporting a hazard ratio and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled hazard ratios were computed and weighted using generic inverse-variance and random-effect modeling. All statistical tests were two-sided.
  
  
  RESULTS
  One hundred studies comprising 40559 patients were included in the analysis, 57 of them published in 2012 or later. Median cutoff for NLR was 4. Overall, NLR greater than the cutoff was associated with a hazard ratio for OS of 1.81 (95% CI = 1.67 to 1.97; P < .001), an effect observed in all disease subgroups, sites, and stages. Hazard ratios for NLR greater than the cutoff for CSS, PFS, and DFS were 1.61, 1.63, and 2.27, respectively (all P < .001).
  
  
  CONCLUSIONS
  A high NLR is associated with an adverse OS in many solid tumors. The NLR is a readily available and inexpensive biomarker, and its addition to established prognostic scores for clinical decision making warrants further investigation.
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Arnoud J
authors.initials: AJ
authors.lastname: Templeton
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Mairéad G
authors.initials: MG
authors.lastname: McNamara
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Boštjan
authors.initials: B
authors.lastname: Šeruga
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Francisco E
authors.initials: FE
authors.lastname: Vera-Badillo
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Priya
authors.initials: P
authors.lastname: Aneja
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Alberto
authors.initials: A
authors.lastname: Ocaña
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Raya
authors.initials: R
authors.lastname: Leibowitz-Amit
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Ben
authors.initials: B
authors.lastname: Tran
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT).
authors.forename: Ian F
authors.initials: IF
authors.lastname: Tannock
authors.affiliation: Affiliations of authors: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (AJT, MGM, FEV-B, PA, RL-A, JJK, IFT, EA); Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia (BS); Medical Oncology University Hospital, Albacete, Spain (AO); University of Alabama, Birmingham Comprehensive Cancer Center, Birmingham, AL (GS); Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia (BT). eitan.amir@uhn.ca.
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology*; D009504:Neutrophils / Q000473:pathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome