Systematic Review and Meta-Analysis of the Prognostic Significance of Neutrophil-Lymphocyte Ratio (NLR) After R0 Gastrectomy for Cancer

Purpose

A meta-analysis was performed to evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR) in patients undergoing potentially curative gastrectomy for cancer (GC).

Methods

Thomson Reuters Web of Science, Ovid MEDLINE(R) and PUBMED databases were searched for relevant articles using search terms neutrophil-lymphocyte ratio (NLR), GC and survival. Articles reporting overall survival (OS), cancer-specific survival and disease-free survival (DFS), in patients undergoing R0 gastrectomy, were studied.

Results

Articles numbering 365 were identified during the preliminary search, and 10 containing 4164 patients were included in the final review. Most patients were >?60 years of age, male (67%) and 2239 (53.8%) had pT3 disease. The number of NLR dichotomization thresholds reported numbered 7, with 2.00 and 3.00 (n?=?2) the most common. NLR was associated with poor survival in eight studies with hazard ratios ranging from 1.54 (95% confidence interval (CI) 1.26–1.89) to 2.99 (1.99–4.49). Pooled odds ratio (OR) for OS was 2.31 (1.40–3.83, p?=?0.001) and for DFS 2.72 (1.14–6.54, p?=?0.020). Four studies presented T-stage data, OR 1.62 (1.33–1.96, p?

Conclusion

NLR is an important prognostic indicator associated with both OS and DFS after R0 resection of GC, but the critical level is equivocal.