Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis

Arnoud J. Templeton, Mairéad G. McNamara, Boštjan Šeruga, Francisco E. Vera-Badillo, Priya Aneja, Alberto Ocaña, Raya Leibowitz-Amit, Guru Sonpavde, Jennifer J. Knox, Ben Tran, Ian F. Tannock, Eitan Amir

Research output: Contribution to journalReview articlepeer-review

Abstract

Background Inflammation may play an important role in cancer progression, and a high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a poor prognostic indicator in several malignancies. Here we quantify the prognostic impact of this biomarker and assess its consistency in solid tumors. Methods A systematic review of electronic databases was conducted to identify publications exploring the association of blood NLR and clinical outcome in solid tumors. Overall survival (OS) was the primary outcome, and cancer-specific survival (CSS), progression-free survival (PFS), and disease-free survival (DFS) were secondary outcomes. Data from studies reporting a hazard ratio and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled hazard ratios were computed and weighted using generic inverse-variance and random-effect modeling. All statistical tests were two-sided. Results One hundred studies comprising 40559 patients were included in the analysis, 57 of them published in 2012 or later. Median cutoff for NLR was 4. Overall, NLR greater than the cutoff was associated with a hazard ratio for OS of 1.81 (95% CI = 1.67 to 1.97; P <. 001), an effect observed in all disease subgroups, sites, and stages. Hazard ratios for NLR greater than the cutoff for CSS, PFS, and DFS were 1.61, 1.63, and 2.27, respectively (all P <. 001). Conclusions A high NLR is associated with an adverse OS in many solid tumors. The NLR is a readily available and inexpensive biomarker, and its addition to established prognostic scores for clinical decision making warrants further investigation.

Original languageEnglish
JournalJournal of the National Cancer Institute
Volume106
Issue number6
DOIs
StatePublished - 11 Jun 2014
Externally publishedYes

Fingerprint

Dive into the research topics of 'Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this