Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients

Abstract

Abstract. Current evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) may be a biomarker for poor prognosis in lung cancer, although this association remains controversial. Therefore, a meta-analysis was performed to evaluate the association between NLR and lung cancer outcome. A systematic literature search was performed through the PubMed, Embase and Cochrane Library databases (until July 30, 2016), to identify studies evaluating the association between NLR and overall survival (OS) and/or progression-free survival (PFS) among patients with lung cancer. Based on the results of this search, data from 18 studies involving 7,219 patients with lung cancer were evaluated. The pooled hazard ratio (HR) suggested that elevated pretreatment NLR predicted poor OS [HR=1.46, 95% confidence interval (CI): 1.30-1.64] and poor PFS (HR=1.42, 95% CI: 1.15-1.75) among patients with lung cancer. Subgroup analysis revealed that the prognostic value of NLR for predicting poor OS increased among patients who underwent surgery (HR=1.50, 95% CI: 1.21-1.84) or patients with early-stage disease (HR=1.64, 95% CI: 1.37-1.97). An NLR cut-off value of ≥4 significantly predicted poor OS (HR=1.56, 95% CI: 1.31-1.85) and PFS (HR=1.54, 95% CI: 1.13-1.82), particularly in the cases of small-cell lung cancer. Thus, the results of the present meta-analysis suggested that an elevated pretreatment NLR (e.g., ≥4) may be considered as a biomarker for poor prognosis in patients with lung cancer.

Neutrophil to Lymphocyte Ratio as a Prognostic Factor in European Patients with Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Treated with Tyrosine Kinase Inhibitors

“…Moreover, there is no exact cut-off point for NLR that can be applied in clinical practice. Almost every study reports its own cut-off for NLR, ranging from 2.11 to 5, although the best cut-off value derived in meta-analysis seems to be ≥ 4 [19,20,21]. We found that an NLR ≥ 4.39 was associated with worse survival in our patient population.…”

“…Several laboratory markers of SI have been confirmed as prognostic factors in many types of cancer, including plasma concentration of albumin, C-reactive protein, hemoglobin, platelets, and absolute values of white cells and its components (neutrophils, lymphocytes, monocytes) [16]. The neutrophil to lymphocyte ratio (NLR) is one of the most easy and inexpensive methods to estimate SI, and its value as a prognostic factor has been recognized in a wide variety of tumors, including NSCLC in both early and advanced stages [17,18,19,20,21]. However, information about the prognostic significance of NLR in EGFR-mutant advanced NSCLC is scarce, and almost all of the studies published to date have been conducted in Asian populations [20,22,23,24,25,26,27].…”

Neutrophil‐to‐lymphocyte ratio and risk of lung cancer mortality in a low‐risk population: A cohort study

“…With regard to lung cancer, however, most previous studies on NLR or PLR in lung cancer have focused on the prognostic role of NLR or PLR, demonstrating that elevated PLR and elevated NLR are associated with poor prognosis in patients with lung cancer . Until now, only one study has evaluated the association of NLR and PLR with development of lung cancer in individuals without lung cancer at baseline .…”

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

“…Recently, several meta-analyses 13,14 with regard to the prognostic role of NLR in cancer targeted therapy or chemotherapy were published. These studies have shown the value of NLR as a biomarker in predicting outcomes of patients with advanced lung cancer.…”

“…Blood-based parameters, such as NLR, have been reported to predict outcomes in cancer patients. A number of meta-analyses 13–15 have suggested that NLR is a good predictive biomarker in predicting efficacy of chemotherapy and molecular targeted therapy in various cancer types. Since 2017, retrospective studies 5,16–19 evaluating the role of NLR in predicting outcomes of NSCLC patients receiving immune checkpoint inhibitors have been released.…”