Neutrophil-to-lymphocyte ratio as prognostic marker in esophageal cancer: a systematic review and meta-analysis

Abstract

A high preoperative neutrophil-lymphocyte ratio (NLR) has been shown in several studies as a predictor of worse survival in many solid neoplasms, including esophageal cancer, but its impact remains unclear. The goal of this systematic review was to gain all the evidence about NLR in order to analyse its potential in predicting survival in esophageal cancer. Therefore, we conducted a systematic literature search of all relevant studies reporting data on NLR as prognostic marker in esophageal cancer patients.We considered overall survival (OS) as primary outcome, disease-free survival (DFS) and progression-free survival (PFS) as secondary outcomes. We included studies with a directly or indirectly available hazard ratio (HR), furthermore we used both fixed effect model and random effect model depending on heterogeneity.We included a total of 20 studies, published between 2011 and 2017, consisting of 6,457 patients. The NLR cut-off value ranges from 1.7 to 5. The HR for OS of all included studies was 1.60. The HR for DFS and PFS was 1.75 and 1.66 respectively. The survival sub-analysis about tumor characteristics, treatment modality, blood sample timing also confirmed NLR prognostic relevance with statistically significant results.The meta-analysis showed that high preoperative NLR is associated with worse survival in esophageal cancer, as shown in several solid tumors, but its use in the clinical practice is still underestimated. Highquality studies are needed to assess the most effective cut-off in survival prognostication and NLR relevance on postoperative complications.

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

“…1,6 It can also be used for mortality stratification in major cardiac events. 7,8 Several studies have revealed the significance of NLR as prognostic factor in patients with solid tumors such as gastric cancer, 9 breast cancer, 10 head and neck cancers, 11 hepatic cell carcinoma, 12 lung cancer, 13 esophageal cancer, 14 melanoma. 15 Similarly, application of LMR as a prognostic factor is under close investigation.…”

Neutrophil to lymphocyte ratio as a predictor of response to neoadjuvant chemotherapy and survival in oesophageal adenocarcinoma

“…A high mGPS was associated with poor response to NAC in rectal cancer (odds ratio (OR) 0·18, P = 0·006), and low NLR was associated with a good pathological response (OR 0·27, P = 0·046), although this did not retain independent significance in multivariable analysis. Although other studies have not specifically examined the role of SIR's association with pathological response to NAC, preoperative NLR has been reported to predict overall survival, with high NLR values being associated with poor survival. Exactly why SIR should be associated with poor response to neoadjuvant chemotherapy in OAC is not understood, although in vivo and in vitro evidence suggests that activation of the JAK/STAT3 (Janus kinase/signal transducers and activators of transcription) pathway by interleukin 6 may play a role in chemoresistance.…”

Establishment and Validation of a Prognostic Model in Patients with Stage T1-3N0M0 of Esophageal Squamous Cell Carcinoma (ESCC): An Observational Study from Two Centers

“…The existing research had identified specific factors that have a direct influence on the occurrence and progress of EC. These factors include the following: the level of preoperative C-reactive protein/albumin ratio [10], neutrophil-to-lymphocyte ratio [11], thoracic lymph nodes metastasis [12], and other factors [13][14][15][16][17][18]. However, there are no methods that would accurately predict postoperative prognosis in patients with stage T1-3N0M0 ESCC.…”