Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer

Mady, Mohamed; Prasai, Kritika; Tella, Sri Harsha; Yadav, Siddhartha; Hallemeier, Christopher L.; Rakshit, Sagar; Roberts, Lewis R.; Borad, Mitesh J.; Mahipal, Amit

doi:10.1016/j.hpb.2020.02.002

Cited by 20 publications

(12 citation statements)

References 29 publications

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“…After removal of duplicates, we browsed the titles and abstracts of the remaining 134 studies, and 107 studies were excluded according to the inclusion and exclusion criteria. Then we assessed full-text review of the remaining 27 studies, another 13 studies were excluded and finally 14 retrospective cohort studies were included for meta-analysis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Basic characteristics of included studies were listed in Table 1.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Despite the robust and growing data regarding the utility of these WBCC-derived indexes, findings are not uniform across all publications. Furthermore, previous studies mainly focused on colorectal, pancreatic, prostate, lung, esophageal-gastric and breast cancers (7), only few studies conducted investigations on GBC until recently (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Based on the available data, we aimed to systematically review and rationalize the evidence for the prognostic value of these WBCC-derived indexes in predicting outcomes of GBC patients.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Value of Peripheral Whole Blood Cell Counts Derived Indexes in Gallbladder Carcinoma: A Systematic Review and Meta-Analysis

Chen

Zhang

et al. 2021

Front. Oncol.

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BackgroundGallbladder carcinoma (GBC) is a rare gastrointestinal malignancy with poor prognosis. Adequate pre-treatment prediction of survival is essential for risk stratification and patient selection for aggressive surgery or adjuvant therapeutic strategy. Whole blood cell count (WBCC) derived indexes are broadly used as prognosticative biomarkers in various cancer types, but their utility in GBC needs to be validated.MethodsAn extensive literature review was conducted in line with PRISMA guideline until June 31 2020, to identify original studies concerning WBCC-derived indexes as prognostic indicators in GBC. All relative parameters were extracted and pooled for statistical analyses.ResultsFourteen studies incorporating 2,324 patients were included with a high quality and low risk of biases. All 14 studies evaluated the prognostic value of NLR showing a significant correlation with OS in GBC patients (HR = 1.94, P <0.001). Elevated NLR was revealed to correlate with TNM stage (stages III and IV, OR = 4.65, P <0.001), tumor differentiation (OR = 2.37, P <0.042), CA 19-9 (SMD = 0.47, P = 0.01), but no significance was found with age, sex and CEA. Positive indicative value of MLR and PLR were also confirmed with a HR of 2.06 (P <0.001) and 1.34 (P <0.001), respectively.ConclusionThe WBCC-derived indexes including NLR, MLR/LMR and PLR were validated to be useful prognostic parameters for predicting survival outcomes in GBC patients. These series of indexes, especially NLR, could improve risk stratification and facilitate better patient selection for surgical resection or aggressive chemotherapy in the decision making of GBC patients.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Peripheral Whole Blood Cell Counts Derived Indexes in Gallbladder Carcinoma: A Systematic Review and Meta-Analysis

Chen

Zhang

et al. 2021

Front. Oncol.

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“…The medical centres covered by this study did not routinely analyse whole differential white blood cell counts, making it impossible to perform calculations on NLR, which previously have been shown to be a prognostic marker for both OS and PFS [ 24 , 25 , 26 ]. Some studies have however investigated the use of dNLR and found it to be a reasonable surrogate for NLR [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Real-World Evidence on Palliative Gemcitabine and Oxaliplatin (GemOx) Combination Chemotherapy in Advanced Biliary Tract Cancer

Lagenfelt

Blomstrand

Elander

2021

Cancers

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Background: Gemcitabine and oxaliplatin (GemOx) is a standard combination regimen in advanced biliary tract cancer (BTC). There is limited evidence on its efficacy and safety in real life. Methods: A retrospective multicentre cohort study in the South East Region of Sweden, covering nine years (2011–2020) and three hospitals where GemOx was treatment of choice, was designed. Clinicopathological prognostic parameters were explored. Results: One hundred and twenty-one patients with advanced BTC were identified. Median overall and progression-free survival (OS and PFS) were 8.9 (95% CI = 7.2–10.6) and 5.3 (95% CI = 3.8–6.7) months. Performance status according to Eastern Cooperative Oncology Group (PS according to ECOG) 1–2 and primary gallbladder carcinoma were independent predictors for poor OS. PS and derived neutrophil/lymphocyte ratio were predictive for PFS. The most common severe type of myelosuppresion was grade 3 neutropenia that was recorded in 8%. Fifty-three (43.8%) experienced at least one episode of unplanned hospitalisation. One hundred and seventeen (97%) received oxaliplatin with lower dosage than was utilized in previous phase III trials (80–85 vs. 100 mg/m2) and a majority received further dose reductions of oxaliplatin and/or gemcitabine. Conclusion: The outcome of GemOx in advanced BTC appears comparable in controlled trials and real-world contexts. A lower dose of oxaliplatin seems more tolerable without compromising the outcome.

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We recently read with great interest the article by Mady et al titled 'Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer' . 1 In that article the authors aimed to evaluate the association between NLR and overall survival in patients with metastatic gallbladder cancer. The authors determined that NLR is an independent predictor of poor prognosis in patients with metastatic GBC.

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confidence: 99%

NLR as a prognostic marker in metastatic gallbladder cancer?

Düzenli

Köseoğlu

2020

HPB

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We recently read with great interest the article by Mady et al. titled 'Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer' . 1 In that article the authors aimed to evaluate the association between NLR and overall survival in patients with metastatic gallbladder cancer. The authors determined that NLR is an independent predictor of poor prognosis in patients with metastatic GBC. The availability of this parameter at no additional cost may encourage its utilization in clinical practice. While we found these results important and would like to thank the authors for their contribution, we would also like to direct the attention of readers to some methodological issues.NLR is a globally available and inexpensive laboratory parameter, which is used to test systemic inflammation. NLR has been reported to be prognostic in several solid tumors including gastrointestinal malignancies. On the other hand, it was shown that chronic hepatitis B or C infection, renal failure, diabetes mellitus, valvular heart diseases, acute coronary syndromes, thyroid functional abnormalities, metabolic syndrome, essential hypertension, and many inflammatory diseases may also potentially affect NLR. 2,3 Thus, it would be more relevant if Mady et al. had mentioned these NLR-affecting factors while evaluating the relationship between NLR in in patients with metastatic gallbladder cancer. And also, medication may easily alter NLR, so it would have been useful if the patients were described in greater detail in terms of, anti-inflammatory drugs, antiviral agents, immunosuppressive drugs, and/or other medications. Finally, it would also have been better if the authors indicated the elapsed time between taking the blood samples and measuring NLR, since the waiting period prior to analysis may affect this laboratory parameters. 2,3 We believe that the findings of Mady et al. 1 will lead to further research concerning the relationship between NLR and metastatic gallbladder cancer. However, it should be kept in mind that NLR itself alone may not secure true information about survival in patients with metastatic gallbladder cancer.

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Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer

Cited by 20 publications

References 29 publications

Prognostic Value of Peripheral Whole Blood Cell Counts Derived Indexes in Gallbladder Carcinoma: A Systematic Review and Meta-Analysis

Prognostic Value of Peripheral Whole Blood Cell Counts Derived Indexes in Gallbladder Carcinoma: A Systematic Review and Meta-Analysis

Real-World Evidence on Palliative Gemcitabine and Oxaliplatin (GemOx) Combination Chemotherapy in Advanced Biliary Tract Cancer

NLR as a prognostic marker in metastatic gallbladder cancer?

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