Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background and Aims: Published data on the prognostic role of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer are controversial. We conducted this meta-analysis to obtain a more accurate assessment of prognostic significance of NLR in ovarian cancer. Materials and Methods: We conducted a systematic literature search using the electronic databases PubMed, Web of Science, and Embase up to May 2016. Hazard ratio (HR) and odd ratio (OR) with 95% confidence interval (95% CI) were calculated. Subgroup analyses were carried out to explore the source of heterogeneity. Statistical analysis was performed using Stata 10.0. Results: A total of 12 studies, consisting of 3,854 patients, which met our criterion were selected in this meta-analysis. Our pooled results showed that high pre-treatment NLR level was significantly associated with poorer overall survival (OS) (HR: 1.69, 95% CI 1.29-2.22) and shorter progression free survival (PFS) (HR 1.63, 95% CI 1.27–2.09). Additionally, increased NLR was also significantly correlated with advanced FIGO stage (OR 2.32, 95% CI1.79-3.00), higher serum level of CA-125 (OR 3.33, 95% CI 2.43-4.58), more extensive ascites (OR 3.54, 95% CI 2.31-5.42) as well as less chemotheraputic response (OR 0.53, 95% CI 0.40-0.70). The findings from most of subgroup meta-analyses were consistent with those from the overall meta-analyses. Conclusions: Elevated pre-treatment NLR could served as a predicative factor of poor prognosis for ovarian cancer patients.

Mature neutrophils suppress T cell immunity in ovarian cancer microenvironment

“…The concept of a myeloid bias can also apply to mature PMN. In patients with EOC, the pretreatment circulating PMN count (25) and the PMN/lymphocyte ratio (26) correlated with poor outcomes. Moreover, activated PMN can acquire a suppressive phenotype (27)(28)(29).…”

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

“…More recently, SIR-related biomarkers, such as C-reactive protein (CRP) [12], the lymphocyte-monocyte ratio (LMR) [13], and the platelet-lymphocyte ratio (PLR) [14], have been investigated as potential predictors in bladder cancer. The neutrophil-lymphocyte ratio (NLR) has also been investigated as an economic and readily available predictor for bladder tumors in a few studies [15-19]. …”

Combined Plasma Fibrinogen and Neutrophil Lymphocyte Ratio in Ovarian Cancer Prognosis May Play a Role?

“…Neutrophil-to-lymphocyte ratio, calculated as neutrophil count divided by lymphocyte count, is suggested as a marker for survival outcomes in a variety of cancers, including OC, 12 because of its performance and availability. 16 It is thought that an elevated level of NLR reflects increased systemic inflammatory changes in the host, which may be associated with poorer survival in OC. 17 Based on NLR values, an additional prognostic score, combining NLR and fibrinogen levels (F-NLR), has been proposed in different tumors, 18 with interesting results.…”