中性粒细胞与淋巴细胞比率评估胃癌预后的Meta分析

目的分析探讨中性粒细胞与淋巴细胞比率(neutrophil-lymphocyte ratio, NLR)对胃癌患者预后评估的价值。 方法采用循证医学的meta分析研究。首先,从Embase、Medline和Web of Science数据库中检索关键词gastric cancer、stomach cancer、gastric carcinoma、stomach carcinoma、gastric neoplasm、stomach neoplasm、neutrophil和lymphocyte。然后,根据各纳入研究的总生存率(overall survival, OS)和无进展生存期(progression-free survival, PFS)/无疾病生存期(disease-free survival, DFS)合并生存危险比(hazard ratio, HR)的异质性,决定用固定或随机效应模型计算OS和PFS/DFS的合并HR。若合并HR>1,且其95%可信区间(confidence interval, CI)也>1, 则为NLR升高与胃癌患者OS或PFS/DFS的降低有显著联系。 结果收集18篇文献共纳入5 065例胃癌患者进行meta分析。升高的NLR与OS降低存在显著关联(HR为1.79,95%CI 1.54~2.08)。亚组分析中,胃癌多种治疗方案组和化疗组NLR升高均与OS降低存在显著关联HR分别为1.84, (95% CI 1.48~2.29)和1.69, (95% CI 1.41~2.03)];而NLR≤3.2组和NLR>3.2组亦均与OS的降低存在显著关联HR分别为1.80, (95% CI 1.46~2.23)和1.93, (95% CI 1.58~2.36)]。在胃癌患者OS的单因素meta回归分析中, 发表年份、种族、NLR临界值、治疗方案、患者数、进展期患者比例和男性比例都不是引起胃癌患者异质性来源的可能原因(P值分别为0.585、0.887、0.731、0.697、0.613、0.877、0.775)。 结论胃癌患者中升高的NLR与OS降低存在显著的关联,NLR可作为评价胃癌患者预后的标志物。

Prognostic value of neutrophil-lymphocyte ratio in gastric cancer: a meta-analysis

ObjectiveThe neutrophil-lymphocyte ratio (NLR) may indicate the balance of the inflammatory and immune systems, making NLR a useful index to evaluate tumor development. However, its prognostic value in patients with gastric cancer was still unclear. A meta-analysis was performed to characterize the prognostic effect of NLR. MethodsAn extensive literary search for relevant studies was conducted on Embase, Medline and Web of Science databases. The search strategy included the following keywords "gastric cancer", "stomach cancer", "gastric carcinoma", "stomach carcinoma", "gastric neoplasm", "stomach neoplasm", "neutrophil" and "lymphocyte" . Effect measure was hazard ratio (HR) for overall survival (OS) and progression-free survival(PFS) /disease-free survival (DFS). Then pooled HRs and 95% confidence intervals (CIs) were calculated using the random or fixed effect models by the heterogeneity of included studies. The pooled HR and 95% CI >1 indicated elevated NLR was associated with a significantly poorer OS. ResultsThis meta-analysis has been based on 18 publications and comprises a total of 5 065 patients with gastric cancer. The pooled HR showed that elevated NLR was associated with a significantly poorer OS (HR 1.79, 95%CI 1.54-2.08). Subgroup analysis showed the prognostic effect of NLR was identical in multiple treatment methods subgroup and chemotherapy subgroupHR 1.84, (95% CI 1.48-2.29) and 1.69, (95% CI 1.41-2.03), respectively]. The same effect was also seen in NLR≤3.2 subgroup and NLR>3.2 subgroup HR 1.80, (95% CI 1.46-2.23) and 1.93, (95% CI 1.58-2.36), respectively]. At univariate meta-regression analysis in OS, the results indicated publication year, ethnicity, NLR cutoff value, treatment type, sample size, proportion of patients in advanced stage and proportion of male did not contribute to the cause of heterogeneity(P value of 0.585, 0.887, 0.731, 0.697, 0.613, 0.877, 0.775). ConclusionThe overall findings of this study support the hypothesis that elevated NLR is associated with a significantly poorer OS and NLR could be a prognostic marker in gastric cancer.