title: Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to predict oncologic outcomes in patients with various types of cancer. However, their prognostic value in patients with esophageal cancer is unclear. In this meta-analysis, we evaluated the prognostic significance of NLR and PLR in esophageal cancer patients.
  
  
  METHODS
  We performed comprehensive searches of electronic databases to identify studies that evaluated the prognostic impact of pretreatment NLR and PLR in esophageal cancer patients. The end points were overall survival (OS), disease-free survival, and clinicopathologic parameters. A meta-analysis using random-effects models was performed to calculate hazard ratios (HRs) or odds ratios with 95 % confidence intervals (CIs).
  
  
  RESULTS
  Seven retrospective, observational, cohort studies involving 1540 patients were included. All seven studies evaluated NLR, and four evaluated PLR. Both high NLR (HR 1.40, 95 % CI 1.08-1.81, P = 0.01) and high PLR (HR 1.59, 95 % CI 1.14-2.21, P = 0.006) were significantly predictive of poorer OS. NLR was not a significant predictor of disease-free survival. High PLR (HR 1.85, 95 % CI 1.50-2.28, P < 0.00001) but not NLR was significantly predictive of poorer OS in a subgroup of patients who underwent curative surgery without neoadjuvant chemoradiation. Both high NLR and high PLR were significantly associated with deeper tumor invasion and lymph node metastasis.
  
  
  CONCLUSIONS
  NLR and PLR are associated with tumor progression and are predictive of poorer survival in patients with esophageal cancer. These ratios may thus help to inform treatment decisions and predict treatment outcomes.
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.|Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.
authors.forename: Hariruk
authors.initials: H
authors.lastname: Yodying
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan. a-matsu@nms.ac.jp.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakurazawa
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Marina
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.|Department of Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D001792:Blood Platelets / Q000473:pathology*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate