Clinical Significance of Pre-treated Neutrophil-Lymphocyte Ratio in the Management of Urothelial Carcinoma: A Systemic Review and Meta-Analysis

Abstract

Purpose: We performed a study-level meta-analysis to summarize the current evidence on the correlation between pretreatment neutrophil-to-lymphocyte ratios (NLR) and oncological outcomes in each type of management for urothelial carcinoma. Method: All articles published until February 2017 in PubMed, Scopus, and EMBASE database were collected and reviewed. The current evidence on correlations between pretreatment NLR and oncological outcomes in each type of management for urothelial carcinoma, including transurethral resection of bladder tumor (TURBT), radical cystectomy (RCx), chemotherapy (CTx), and nephroureterectomy (NUx), were summarized. Results: Thirty-eight studies containing clinical information on 16,379 patients were analyzed in this study. Pooled hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals were calculated after weighing each study. Heterogeneity among the studies and publication bias were assessed. Pretreatment NLR was significantly associated with muscle invasiveness (OR: 4.27), recurrence free survival (RFS, HR: 2.32), and progression-free survival (PFS, HR: 2.45) in TURBT patients. In the RCx patients, high NLR was negatively associated with both disease status (extravesical extension and lymph-node positivity, OR: 1.14 and 1.43, respectively) and oncological outcomes [overall survival (OS), PFS], and cancer specific survival (CSS, HR: 1.18, 1.12, and 1.35, respectively). Pretreatment NLR was negatively correlated with pathologic downstaging (OR: 0.79) and positively correlated with PFS (HR: 1.30) and OS (HR: 1.44) in CTx patients. For patients who underwent NUx, pretreatment NLR was significantly associated with OS (HR: 1.72), PFS (HR: 1.63), and CSS (HR: 1.68). Conclusions: Pretreatment NLR is a useful biomarker for disease aggressiveness, oncological outcome, and treatment response in the management of patients with urothelial carcinoma. More evidence is needed to clarify these results.

Inflammatory indexes are not associated with sarcopenia in Chinese community-dwelling older people: a cross-sectional study

“…The inflammatory indexes have been widely studied in patients with malignant diseases [ 12 ] and neurodegenerative diseases [ 13 ]. Some studies demonstrated that the inflammatory indexes were associated with other inflammatory indicators, such as IL-6, CRP, and TNF-α, and were useful for predicting disease progression, treatment response, and prognosis [ 12 , 31 ]. These findings imply that the inflammatory indexes may reflect the degree of inflammation in these diseases.…”

“…One explanation for the discrepancy of these results may be the reporting and publication bias. For example, in a meta-analysis about the correlation of NLR with outcomes of urothelial carcinoma, publication bias could not be excluded by inverted funnel plots [ 12 ]. An analysis of 1915 publications on cancer prognostic markers found that almost all articles reported statistically significant results [ 33 ].…”

“…The inflammatory indexes, i.e., platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), are calculated based on the neutrophil, lymphocyte, monocyte, and platelet counts that are routinely tested in most clinical settings worldwide. They are easily measurable and inexpensive, and have been regarded as important indicators of systemic inflammation [ 9 , 10 ] and serve as predictive biomarkers in patients with coronary heart disease [ 11 ], various malignancies [ 12 ], and neurodegenerative disease [ 13 ]. Recently, a case-control study showed that NLR was an independent predictor for sarcopenia in Turkish older people admitted to the outpatient clinics [ 14 ].…”

<p>A Retrospective Cohort Study on Pretreated Neutrophil-to-Lymphocyte Ratio and Prognosis of Small Cell Lung Cancer: Evidence of Effect Modification by Chemotherapy Regimen</p>

“…Recent studies have found NLR to be related to inferior prognosis in various solid tumors. 5,11,12,16,28 A higher NLR value often indicates a higher neutrophil or lower lymphocyte count. Neutrophils can secrete essential factors, including IL-8, VEGF, and elastase for tumor growth and metastases.…”

“…9,10 Previous studies have presented that NLR could serve as a systemic inflammatory response index to provide important information regarding inflammation and immune state. NLR has been identified as a prognostic biomarker in several cancer types, including urinary tract epithelial tumors, prostate cancer, and non-small cell lung cancer (NSCLC), [11][12][13][14] although the relationship between NLR and long-term outcomes in SCLC remains to be completely understood. Thus, this study was designed to further explore the effects of NLR on the prognosis and identify other factors that modify this association in patients with SCLC.…”