Prognostic significance of neutrophil-lymphocyte ratio in hepatocellular carcinoma: a meta-analysis

Abstract

BackgroundsNeutrophil-lymphocyte ratio (NLR) has recently been reported as a predictor of Hepatocellular carcinoma (HCC). However, its prognostic value in HCC still remains controversial. In this study, we aimed to evaluate the association between NLR and clinical outcome of HCC patients by performing meta-analysis.MethodsA comprehensive literature search for relevant studies published up to August 2013 was performed by using PubMed, Ovid, the Cochrane Library and Web of Science databases. Meta-analysis was performed using hazard ratio (HR) or odds ratio (OR) and 95% confidence intervals (95% CIs) as effect measures.ResultsA total of 15 studies encompassing 3094 patients were included in this meta-analysis. Our pooled results showed that high NLR was associated with poor overall survival (OS) and disease free survival (DFS) in HCC initially treated by liver transplantation (HR = 3.42, 95% CI:2.41-4.85,P = 0.000; HR = 5.90, 95% CI:3.99-8.70,P = 0.000, respectively) and surgical resection (HR = 3.33, 95% CI:2.23-4.98, P = 0.000; HR = 2.10, 95% CI: 2.06–2.14, respectively). High NLR was also associated with poor OS in HCC treated by radiofrequency-ablation (HR = 1.28, 95%CI: 1.10-1.48, P = 0.000), TACE (HR = 2.52, 95% CI: 1.64-3.86, P = 0.000) and mixed treatment (HR = 1.85, 95% CI: 1.40-2.44, P = 0.000), respectively. In addition, high NLR was significantly correlated with the presence of vascular invasion (OR = 2.69, 95% CI: 2.01–3.59, P = 0.000), tumor multifocality (OR = 1.74, 95% CI: 1.30–2.34, P = 0.000) and higher incidence of AFP ≥ 400 ng/ml (OR = 1.46, 95% CI: 1.01–2.09, P = 0.04).ConclusionElevated NLR indicates a poor prognosis for patients with HCC. NLR may be a convenient, easily-obtained, low cost and reliable biomarker with prognostic potential for HCC.

Upregulation of hyaluronan-mediated motility receptor in hepatocellular carcinoma predicts poor survival

“…More than 600,000 people lose their lives due to HCC every year (3), and HCC is the third most frequent cause of cancer-associated mortality (4). Previous studies have demonstrated that the incidence rate of HCC has been increasing.…”

The systemic inflammatory response as a prognostic factor for advanced hepatocellular carcinoma with extrahepatic metastasis

“…Of those, NLR is one of the simplest and most effective inflammatory markers, and is associated with a poor prognosis in various types of cancer (25)(26)(27). A meta-analysis of the usefulness of NLR as a prognostic factor in HCC was recently published (28). The results indicated that the NLR cut-off value varied according to various treatments, such as transplantation, hepatectomy, RFA and TACE.…”

“…It has been reported that the mechanism causing neutrophilia involves a systemic̸localized inflammatory response to a tumor or virus that leads to microcirculatory changes favorable for cancer progression or metastasis. It has also been suggested that a high NLR correlates with the strong invasion and activation of tumor-related macrophages (TAM) within the tumor, which promotes neutrophilia via cytokines such as interleukin (IL)-6 and IL-8 (28). It has also been demonstrated that neutrophils produce matrix metalloproteinase 9, which is involved in angiogenesis, thus promoting the development of tumors and chemokines, and vascular endothelial growth factor, thereby promoting tumor development and metastasis (29)(30)(31).…”

The Prognostic Impact of Neutrophil Lymphocytic Ratio (NLR) on Survival of Patients with Glioblastoma Multiforme (GBM): A Retrospective Cohort Study

“…The neutrophil-to-lymphocyte ratio (NLR) was examined in many cancers and was found to be elevated in patients with advanced and aggressive disease (Lang et al, 2014;Ozdemir et al, 2014;Chang et al, 2014;Xiao et al, 2014).…”