Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies
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Xingshun Qi1,*,#, Jianjun Li2,*,#, Han Deng1, Hongyu Li1, Chunping Su3, Xiaozhong Guo1,#
1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning 110840, China
2Department of Radiotherapy, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
3Library of Fourth Military Medical University, Xi’an, Shaanxi 710032 China
*These authors have contributed equally
#Joint senior authors
Xingshun Qi, email: firstname.lastname@example.org
Jianjun Li, email: email@example.com
Xiaozhong Guo, email: firstname.lastname@example.org
Keywords: hepatocellular carcinoma, inflammatory, neutrophil, lymphocyte, prognosis
Received: March 26, 2016 Accepted: May 16, 2016 Published: June 10, 2016
Background and aims: Neutrophil to lymphocyte ratio (NLR) is an inflammatory-based marker. A systematic review and meta-analysis was performed to explore the prognostic role of NLR in patients with hepatocellular carcinoma (HCC).
Results: Overall, 598 papers were identified, of which 90 papers including 20,475 HCC patients were finally included. Low baseline NLR was significantly associated with better overall survival (HR = 1.80, 95% CI: 1.59–2.04, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.80–2.76, p < 0.00001). Low post- treatment NLR was significantly associated with better overall survival (HR = 1.90, 95% CI: 1.22–2.94, p = 0.004). Decreased NLR was significantly associated with overall survival (HR = 2.23, 95%CI: 1.83–2.72, p < 0.00001) and recurrence-free or disease-free survival (HR = 2.23, 95% CI: 1.83–2.72, p < 0.00001). The findings from most of subgroup meta-analyses were consistent with those from the overall meta-analyses.
Materials and Methods: All relevant literatures were identified via PubMed, EMBASE, and Cochrane library databases. Hazard ratio (HR) with 95% confidence interval (95%CI) was calculated. Subgroup meta-analyses were performed according to the treatment options, NLR cut-off value ranges, and regions.
Conclusions: NLR should be a major prognostic factor for HCC patients. NLR might be further incorporated into the prognostic model of HCC.
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