The prognostic utility of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with colorectal liver metastasis: a systematic review and meta-analysis

Abstract

The neutrophil-to-lymphocyte ratio is used to reflect body's inflammatory status with prognostic value in different cancers. We aimed to investigate the influence of preoperative NLR in the prognosis of CRLM patients receiving surgery using meta-analysis. Data in Cochrane Library, PubMed, Embase, and Web of Science databases created before October 2022 were recruited. Meta-analysis was carried out with RevMan 5.3 and Stata16 software, and the primary outcome indicators included overall survival (OS), and secondary outcome indicators included disease-free survival (DFS) and relapse-free survival (RFS). The pooled risk ratio (HR) and 95% confidence interval (CI) for each outcome indicator were determined using random-effects models or fixed-effects models. The pooled odds ratio (OR) and corresponding 95% confidence intervals (CI) for NLR and clinicopathological characteristics were determined with a fixed-effects model. 18 papers published between 2008 and 2022 (3184 patients in total) were included. The pooled analysis found that high preoperative NLR was correlated with poor OS (multivariate HR = 1.83, 95% CI = 1.61–2.08, p < 0.01), DFS (multivariate HR = 1.78, 95% CI = 1.16–2.71, p < 0.01) and RFS (multivariate HR = 1.46, 95% CI = 1.15–1.85, p < 0.01), but NLR was not related to clinicopathological features of CRLM patients correlation. In conclusion, NLR is an independent risk factor for poor prognosis in patients with CRLM. More large-scale clinical researches are required in the future to demonstrate the inclusion of preoperative NLR as a prognostic indicator for CRLM patients to guide postoperative adjuvant chemotherapy.

Impact of preoperative white blood cell count on outcomes in different stage colorectal cancer patients undergoing surgical resection: a single-institution retrospective cohort study

“…It was found that tumor-infiltrating lymphocyte counts are associated with peculiar gene expression patterns and bear prognostic information in ovarian cancer [ 37 ]. The meta-analysis showed that preoperative neutrophil-to-lymphocyte ratio is an independent risk factor for poor prognosis in patients with colorectal liver metastasis [ 38 ].…”

Prognostic significance of the Gustave Roussy immune (GRIm) score in cancer patients: a meta-analysis

“…Secondly, as a mature inflammation-related marker, NLR has been widely confirmed to predict short- and long-term adverse outcomes in haematologic and solid tumours [ 35 ]. The underlying mechanism is that neutrophils provide a favourable microenvironment for tumour cell proliferation and promote tumour cell progression and invasion [ 36 ]. Conversely, a reduction in lymphocyte numbers suppresses the immune response to cancer [ 37 ].…”

Neutrophils in the tumor microenvironment: role in tumor progression and potential targeted therapeutic strategy

“…The neutrophil to lymphocyte ratio (NLR) is known to increase in many types of tumors including sarcoma, and is closely related to a shorter OS, disease-free survival, or progression-free survival [64][65][66][67][68] . The high NLR has been considered a biomarker of poor clinical outcomes in gastric, triple-negative breast, colorectal, pancreatic, thyroid, and ovarian cancers and soft tissue sarcoma [69][70][71][72][73][74][75][76] . Moreover, the results of a recent study about sarcomas indicate that high NLR may be associated with chemoresistance [77] .…”