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Review
. 2016 Jul 19;7(29):45283-45301.
doi: 10.18632/oncotarget.9942.

Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies

Xingshun Qi  1 , Jianjun Li  2 , Han Deng  1 , Hongyu Li  1 , Chunping Su  3 , Xiaozhong Guo  1
Affiliations
Review

Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies

Xingshun Qi et al. Oncotarget. .

Abstract

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.

Keywords: hepatocellular carcinoma; inflammatory; lymphocyte; neutrophil; prognosis.

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Conflict of interest statement

CONFLICTS OF INTERESTS None.

Figures

Figure 1
Figure 1. Flowchart of study inclusion
Figure 2
Figure 2. Forest plot evaluating the association between baseline NLR and overall survival in HCC patients
Figure 3
Figure 3. Forest plot evaluating the association between post-treatment NLR and overall survival in HCC patients
Figure 4
Figure 4. Forest plot evaluating the association between NLR change and overall survival in HCC patients
Figure 5
Figure 5. Forest plot evaluating the association between baseline NLR and recurrence-free or disease-free survival in HCC patients
Figure 6
Figure 6. Forest plot evaluating the association between NLR change and recurrence-free or disease-free survival in HCC patients
See this image and copyright information in PMC

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References

    1. Tandon P, Garcia-Tsao G. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int. 2009;29:502–510. - PMC - PubMed
    1. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74. - PubMed
    1. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology. 1998;28:751–755. - PubMed
    1. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology. 2014;146:1691–1700. e1693. - PubMed
    1. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score) J Gastroenterol. 2003;38:207–215. - PubMed