Prognostic significance of neutrophil-to-lymphocyte ratio in biliary tract cancers: a systematic review and meta-analysis

Haowen Tang, Wenping Lu, Bingmin Li, Chonghui Li, Yinzhe Xu and Jiahong Dong _

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Oncotarget. 2017; 8:36857-36868. https://doi.org/10.18632/oncotarget.16143

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Haowen Tang1,*, Wenping Lu1,*, Bingmin Li2,*, Chonghui Li1, Yinzhe Xu1 and Jiahong Dong1,3

1 Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Haidian, Beijing, China

2 Chinese PLA Medical School, Haidian, Beijing, China

3 Center for Hepatopancreatobiliary Diseases, Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, Changping, Beijing, China

* These authors have contributed equally to this work

Correspondence to:

Jiahong Dong, email:

Keywords: neutrophil-lymphocyte ratio; biliary tract cancer; overall survival; relapse free survival; prognosis

Received: December 27, 2016 Accepted: February 28, 2017 Published: March 12, 2017


Background: Inflammation was considered to perform crucial roles in the development and metastasis of malignancies. A heightened neutrophil-lymphocyte ratio has been described to be associated with detrimental survivals in different malignancies. Debate remains over the impact of heightened neutrophil-lymphocyte ratio on survivals in biliary tract cancer. The review evaluated the prognostic value of neutrophil-lymphocyte ratio in biliary tract cancer.

Methods: MEDLINE, the Cochrane Library, EMBASE, and the Chinese SinoMed were systematically searched for relevant articles. Associations between neutrophil-lymphocyte ratio and long-term outcomes were expressed as the hazard ratios and 95% confidence intervals. The odds ratio was utilized to assess the association between neutrophil-lymphocyte ratio and clinicopathological parameters.

Results: Fourteen studies consisting of 3217 patients were analyzed: 1278 (39.73%) in the high pretreatment neutrophil-lymphocyte ratio group and 1939 (60.27%) in the low pretreatment neutrophil-lymphocyte ratio one. The results proved that heightened pretreatment neutrophil-lymphocyte ratio was significantly associated with detrimental overall survival and relapse free survival for biliary tract cancer patients. In addition, elevated neutrophil-lymphocyte ratio was positively correlated with higher carbohydrate antigen 19-9 levels, advanced TNM staging and greater lymph node involvement.

Conclusion: This meta-analysis marked that an increased pretreatment neutrophil-lymphocyte ratio was significantly linked with detrimental long-term outcomes and clinicopathological parameters for patients with biliary tract cancer.

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