术前中性粒细胞与淋巴细胞比值对胰腺癌手术患者预后价值的Meta分析

背景与目的：胰腺癌是恶性程度极高的实体恶性肿瘤之一，因早期缺乏症状导致多数患者确诊时已处于局部进展期或晚期。因此，探索术前判断预后的标志物对临床制定诊疗策略至关重要。目前，术前中性粒细胞与淋巴细胞比率（NLR）与胰腺癌患者预后的关系尚存在争议。本研究使用Meta分析方法，探讨术前NLR与胰腺癌患者术后生存获益之间的关系及其预后价值。方法：计算机检索PubMed、Cochrane Library、Web of Science、中国知网、维普及万方数据库收集术前NLR值与胰腺癌患者术后总体生存期（OS）和无病生存期（DFS）关系的研究，检索时限均从建库至2022年3月31日，由两名评价员独立筛选并纳入文献，提取资料并评价纳入研究的偏倚风险后，利用Revman 5.4和Stata 16.0软件对风险比（HR）和95%可信区间（CI）进行合并，并根据异质性选择对应的效应模型。对纳入研究的文献进行敏感度分析，用Egger回归检验判断纳入文献是否存在显著发表偏倚。结果：共纳入25项回顾性研究，4 796例研究对象。研究中有24篇文献报道了NLR与术后OS之间的关系，6篇报道了NLR与术后DFS之间...

Meta-analysis of prognostic value of preoperative neutrophil-to-lymphocyte ratio in pancreatic cancer surgery patients

Background and Aims Pancreatic cancer is one of the highly malignant solid tumors, and most patients are diagnosed at the locally advanced or late stage due to the lack of early symptoms. Therefore, exploring preoperative prognostic markers is crucial for making diagnosis and treatment strategies in clinical practice. Currently, the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and the postoperative prognosis of pancreatic cancer patients is still controversial. This study was conducted to investigate the association of preoperative NLR with the postoperative survival benefits of pancreatic cancer patients, as well as its prognostic value through a Meta-analysis.Methods The studies concerning the relationship between preoperative NLR values and postoperative overall survival (OS) and disease-free survival (DFS) of pancreatic cancer patients were collected by searching PubMed, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases. The search was limited from the inception of the databases to March 31, 2022. Two reviewers independently screened and included the literature, and then extracted data, and assessed the risk of bias in the included studies. Revman 5.4 and Stata 16.0 software were used to combine the hazard ratio (HR) and 95% confidence interval (CI), and the corresponding effect model was selected based on heterogeneity. Sensitivity analysis was performed on the included studies, and the Egger regression test was used to determine if there was significant publication bias in the included literature.Results A total of 25 retrospective studies with 4 796 subjects were included. Of these, 24 articles reported the relationship between NLR and postoperative OS, and 6 articles reported the relationship between NLR and postoperative DFS. The NLR cutoff values and sample sizes in the included retrospective studies were 2.0-5.0 and 28-442, respectively, and the NOS scores of the included studies were between 6-9. Meta-analysis results showed that pancreatic cancer patients with high preoperative NLR levels had significantly shortened postoperative OS (HR=1.24, 95% CI=1.16-1.33, P<0.000 01) and DFS (HR=1.39, 95% CI=1.21-1.60, P<0.000 01). Subgroup analyses based on different NLR cutoff values also showed that high preoperative NLR levels were significantly associated with shortened postoperative OS and DFS (all P<0.05). As revealed by the sensitivity analysis results, the pooled effect sizes for OS and DFS showed no significant changes. Publication bias analysis showed no significant publication bias in the included studies.Conclusion Pancreatic cancer patients with high preoperative NLR levels have shortened postoperative OS and DFS compared to those with low preoperative NLR levels. Preoperative NLR value is a potential biomarker for evaluating the prognosis and survival benefits of pancreatic cancer patients. Due to limitations in the number and quality of studies, further high-quality research is needed to verify the above conclusions.