The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in small cell lung cancer: A meta-analysis

Lu, Yan; Jiang, Jiaming; Ren, ChaoXiang

doi:10.1371/journal.pone.0230979

Cited by 26 publications

(33 citation statements)

References 36 publications

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“…Our analysis demonstrated that the NLR before surgical resection of NSCLC might reflect the invasiveness of tumours. Higher NLR was associated with advanced cancer stage, which is consistent with the results of a current meta-analysis 4 . Our results further showed preoperative NLR was also linked to worse differentiation, and presence of perineural infiltration.…”

Section: Continuous Nlrsupporting

confidence: 91%

“…Prior studies have reported a variety of inflammation markers as predictors for oncological outcomes in multiple types of cancer . In NSCLC, preoperative NLR, PLR and PNI have been demonstrated to predict cancer recurrence or mortality after tumour resection [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . However, there is little evidence regarding the superior prognostic factor among these inflammation markers in the existing literature.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients

Chang

et al. 2020

Sci Rep

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Clinical and pathological predictors have proved to be insufficient in identifying high-risk patients who develop cancer recurrence after tumour resection. We aimed to compare the prognostic ability of various inflammation markers in patients undergoing surgical resection of lung cancer. We consecutively included 2,066 patients with stage I–III non-small-cell lung cancer undergoing surgical resection at the center between 2005 and 2015. We evaluated prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio along with their perioperative changes. We conducted stepwise backward variable elimination and internal validation to compare the selected markers’ predictive performance for postoperative recurrence-free survival and overall survival. Preoperative neutrophil-to-lymphocyte ratio independently predicts recurrence-free survival (HR: 1.267, 95% CI 1.064–1.509, p = 0.0079, on base-2 logarithmic scale) and overall survival (HR: 1.357, 95% CI 1.070–1.721, p = 0.0117, on base-2 logarithmic scale). The cut-off value is 2.3 for predicting both recurrence (sensitivity: 46.1% and specificity: 66.7%) and mortality (sensitivity: 84.2% and specificity: 40.4%). Advanced cancer stage, poor tumour differentiation, and presence of perineural infiltration were significantly correlated with higher preoperative neutrophil-to-lymphocyte ratio. We concluded that preoperative neutrophil-to-lymphocyte ratio is superior to prognostic nutritional index and platelet-to-lymphocyte ratio in predicting postoperative recurrence and mortality of patients undergoing surgical resection of non-small-cell lung cancer.

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Section: Continuous Nlrsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients

Chang

et al. 2020

Sci Rep

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“…Some reports have showed that NLR and PLR are related to poor prognosis in patients with lung cancer. A meta-analysis demonstrated that high pretreatment NLR was closely related to poorer progression-free survival and overall survival in patients with small-cell lung cancer [ 7 ]. A retrospective descriptive study showed that high PLR was significantly associated with poor overall survival in patients with stage IV non-small-cell lung cancer [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Blood to Distinguish Lung Cancer Patients from Healthy Subjects

et al. 2020

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Objective. Inflammation-driven markers play a crucial role in tumorigenesis and tumor progression. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in blood are systemic inflammatory response markers. Some reports have showed that NLR and PLR are related to a poor prognosis in patients with lung cancer. However, little studies have reported whether NLR and PLR can be diagnostic markers for lung cancer. The aim of the current study is to investigate the roles of NLR and PLR in diagnosing lung cancer. Methods. This study analyzed data from lung cancer patients and healthy individuals in Wuxi People’s Hospital Affiliated with Nanjing Medical University. The Mann–Whitney U test was performed to compare differences between the lung cancer group and the control group. Based on white blood cell (WBC) counts, both lung cancer patients and healthy individuals were divided into the low-level group, moderate-level group, and high-level group. The Kruskal-Wallis test was applied to compare differences of NLR and PLR among those groups with different WBC counts. Spearman correlation analysis was used to assess correlations. Receiver operating characteristic (ROC) curves were performed to determine diagnostic accuracy. Results. 210 patients diagnosed with lung cancer and 261 healthy subjects were enrolled in this study. Levels of NLR and PLR increased in the lung cancer group compared with the control group ( P < 0.001 ). For the lung cancer group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels had no significant variation with the increasing of WBC levels ( P = 0.206 ). For the control group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels would decline with the increasing of WBC levels ( P < 0.001 ). In the lung cancer group, both NLR and PLR had no significant correlations with aspartate transaminase, urea, and glucose. The area under the curve (AUC) with 95% confidence interval (95% CI) of NLR and PLR to distinguish lung cancer patients from healthy subjects was, respectively, 0.684 (0.634-0.735) and 0.623 (0.571-0.674). When NLR and PLR were combined, AUC (95% CI) increased to 0.691 (0.642-0.740). Conclusions. NLR and PLR alone have moderate ability to distinguish lung cancer patients from healthy subjects. Furthermore, combination forms of NLR and PLR can improve diagnostic ability.

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“…Until now, only one systematic review on NLR in SCLC has been performed (56) identifying an association between NLR and OS. In the previous review, 21 studies were included of which six were posters from international conferences and two of these could not be identi ed in the Pubmed, Embase, WOS, or Scopus databases.…”

Section: Discussionmentioning

confidence: 99%

Inflammation Scores as Prognostic Biomarkers in Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Winther‐Larsen

Aggerholm‐Pedersen

Sandfeld-Paulsen

2020

Preprint

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Background: Inflammation scores based on general inflammation markers as leucocyte count or C-reactive protein have been evaluated as prognostic markers of inferior survival in several cancers. In small cell lung cancer (SCLC), however, inflammation scores are less studied. In the present study, we set out to perform a systematic review and meta-analysis investigating reported associations between inflammation scores and overall survival (OS) in SCLC. Methods: A literature search was performed in PubMed, Embase, Scopus, and Web of Science following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Of the identified publications, only studies in English containing original data evaluating inflammation scores as a prognostic factor in SCLC patients were included. Hazard ratios (HRs) for OS were pooled in a random-effects model. Results: In total, 33 articles were included evaluating eight different inflammation scores in 7762 SCLC patients. Seven of the identified scores were based on leucocyte count. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio were the most frequently evaluated scores (NLR: n=23; PLR: n=22). For NLR, a meta-analysis including 16 studies demonstrated that patients with a high NLR had a significantly shorter OS compared to patients with a low NLR (pooled HR=1.39 (95 % CI, 1.23 – 1.56)). For PLR, an association with survival could not be confirmed in a meta-analysis performed based on eight studies (pooled HR=1.20 (95 % CI, 0.96 – 1.51)). Conclusions: This review identifies that inflammation scores based on general inflammation markers have some potential as prognostic biomarkers in SCLC. The meta-analyses indicated that NLR is associated with inferior OS, whereas an association between PLR and OS could not be confirmed. Thus, NLR could be a useful biomarker of OS in SCLC patients. Systematic Review Registrations: The protocol for the study was submitted to the PROSPERO database (registration number CRD42020188553).

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The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in small cell lung cancer: A meta-analysis

Cited by 26 publications

References 36 publications

A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients

A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Blood to Distinguish Lung Cancer Patients from Healthy Subjects

Inflammation Scores as Prognostic Biomarkers in Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

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